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While modern infertility treatment has become
very effective, the sad fact is that there are still many dangerous
infertility treatments to which patients are needlessly subjected. These
treatments not only waste time and energy, they can actually reduce
your fertility !
Let’s first take a look at why there are so many
harmful and ineffective treatments still around. Patients would expect that all
good doctors would offer only safe and effective treatment – so why
should useless and ineffective treatments still exist ?
The reason for this is that infertility is a
complex area, and there is still a lot of confusion about the best
treatment option for many common problems even amongst doctors .
When doctors disagree amongst themselves, how is a patient to make
sense of all the options ?
Most doctors take pride in their own personal
experience , and trust their own clinical judgment. They prefer
doing treatments which have worked in their hands, and this causes
them to become biased. Even though there is no proof that the
treatments are actually helpful, they remember patients who
conceived after taking that treatment. This is called “anecdotal “
experience, and create a bias in each individual doctor’s mind. Few
doctors are broad minded enough to study the scientific literature
critically, and few have the objectivity to practice evidence-based
medicine. It’s easy to get “fooled by randomness” in infertility
medicine, because there are so many variables, and many patients
will get pregnant even inspite of the doctor’s “treatment” ! Of
course, the doctor will take credit for the pregnancy – and patients
too are quite happy to share the credit with their doctor.
The best way to explain this bias is to consider
the example of a doctor who has performed varicocele surgery for 10
men with a low sperm count. Of these, only one succeeds in getting
his wife pregnant. ( This success was not because the surgery
helped, but because his sperm count was not really low in the first
place, since it was done at an unreliable laboratory). This means
that the pregnancy rate for varicocele surgery in this doctor’s hand
is only 10%, and he should his advise his patients accordingly.
However, in real life, what happens is that the other nine patients
who fail to conceive get fed up , and change their doctor. They are
“lost to follow-up”, and the doctor only remembers the one patient
who did get his wife pregnant ( since he comes back with a big smile
and a box of chocolates !) Therefore, he continues to imagine that
pregnancy rates after varicocele surgery in “his clinical
experience” are very high.
The second way doctors often delude themselves (
and their patients) is that even if their patients don’t get
pregnant after the surgery, they still feel the surgery was
justified because the sperm count increased. Thus, they use an
increase in the sperm count as a “surrogate marker” for success in
gauging the effectiveness of their infertility treatment.
However, since it’s well known that sperm counts
fluctuate considerably in any case, it’s hard to credit the surgery
with the increase in the sperm count. Also, men don’t want an
increased sperm count – they want a baby, and from the couple’s
point of view, the surgery is still a failure ( even though the
sperm count did
increase !)
The other complicating factor in assessing the
effectiveness of a treatment is the gullibility of patients, and
their desperation. Infertile couples are so happy to clutch at
straws, that they are willing to pursue any path which offers a
glimmer of hope. This problem has now been compounded by clever
marketing in the “infertility industry”, which leads patients
astray, and misguides them. Let’s look at the example of a patient
who is doing her third IVF cycle. She starts doing acupuncture, and
conceives in her third IVF cycle. In her mind, the fact that she
failed her first two IVF cycles, and conceived only after doing
acupuncture means that it was the acupuncture which was responsible
for her IVF success. In reality, it’s well known that chance has no
memory, and IVF treatments have a cumulative conception rate of
about 30% per cycle for the first 4 cycles, which means she may very
well have conceived in her third cycle even if she hadn’t done the
acupuncture. Unfortunately, patients only have their own personal
experience to go by, and find it hard to be objective. This
particular patient will start swearing by the efficacy of
acupuncture, and recommending it to all infertile couples, thus
causing a myth to spread further. With the advent of the internet,
vocal patients who have succeeded after many IVF attempts carry a
lot of clout on infertility bulletin boards, and they often end up
misleading others ( even though their intentions are good).
Here’s a list of what we feel are dangerous
treatments of which patients should beware !
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Varicocele surgery. The fact that doctors
are still uncertain about the efficacy of varicocele surgery
after so many years is itself is a telling commentary on how
unhelpful this surgery is. While the surgery may improve sperm
counts in some men, objective trials have shown that it is no
better than just watchful waiting.
-
Medical therapy for low sperm counts. This
is another one of those areas where fashions come and go. The
current rage is “antioxidants” and dietary supplements such as
Proxeed. Since they do not need a medical prescription, they can
be sold directly to unwary patients, but no study has documented
an increase in pregnancy rates after any of these treatments.
Even if you read the Proxeed website, all they claim is that
Proxeed improves “sperm health” ( whatever that means !) and
that their clinical trials only show an increase in sperm count
and motility. If you want “healthier sperm” , or an increase in
your sperm count, then go ahead and take these, but if you want
a baby, then they are just a waste of time and money.
-
Surgery for fibroids. Fibroids are very
common benign tumours found in the uterus of many young women.
Some of these women who have fibroids will also have the
misfortune of being infertile, and some of them will then end up
falling in the hands of an enthusiastic knife-happy surgeon who
will advise them to get the fibroids removed. However, most
fibroids are silent bystanders in an infertile woman’s uterus,
and do not need to be removed. The only fibroids which need to
be removed are submucous fibroids, and these can be removed by
doing an operative hysteroscopy. Think many times before
agreeing for myomectomy surgery if you are infertile. You may
get your fibroids removed, but you may also end up with
adhesions, which will reduce your fertility even further !
Often, getting a second opinion also does not help, because even
the next surgeon may still advise surgical removal – after all,
surgeons are happiest when doing surgery !
4. Surgery for removing an ovarian cyst. Ovarian
cysts are very common in young women, which is why they are very
common in infertile women. Because of the frequent use of ultrasound
scanning in treating infertile women, many of these small ovarian
cysts are diagnosed and reported by the sonographer. Once an
infertile woman knows she has an ovarian cyst ( a term she may never
have heard of before), her mind starts playing tricks with her, and
she feels that it is the cyst which is responsible for her
infertility. Sooner or later, she will fall into the hands of an
unscrupulous doctor who agrees with her, and offers to remove the
cyst with “minimally invasive surgery”. The vast majority of ovarian
cysts are of no clinical importance, and do not need to be touched.
They usually regress on their own, and rarely affect fertility.
However, unnecessary surgery to remove a cyst will often cause
infertility, because normal ovarian tissue is also removed at the
time of the cyst removal. No surgery is far less invasive than
“minimally invasive surgery” !
5. Hysteroscopic metroplasty. This has become a
very popular operation in some parts of India. While doing a
hysteroscopy, some over-enthusiastic surgeons will make cuts on the
lateral walls of the uterus, to “broaden” the uterine cavity. The
truth is that fertile uterine cavities come in various shapes and
sizes, and there is no need to change the shape of the cavity. Not a
single study in the medical literature has been published which
shows this procedure helps , and this gratuitous surgery can often
cause intrauterine adhesions and damage the uterus ! Beware of
trigger happy surgeons out to make money.
6. D&C for pregnancy termination . Many doctors
still perform a surgical evacuation of the uterine cavity when a
patient suffers a missed abortion. This used to be a standard
surgical treatment in the past, but leads to intrauterine adhesions
in some women. It is far safer and better to medically terminate
this pregnancy using RU-486
( mifegest) and prostaglandins, as this leaves the uterine cavity
intact.
7. Medical therapy for endometriosis. A
diagnosis of endometriosis is very commonly made in infertile women
when a laparoscopy is performed for them. In fact, the chances of
finding minimal endometriosis are as high as 60%, depending upon how
carefully the doctor looks ! Of course, once the endometriosis is
found, this is then labeled to be the “cause” for the infertility,
when often it is just an innocent “red herring” of no clinical
importance. The damage really starts when doctors treat the
endometriosis by trying to suppress it with Danazol or GnRH
agonists. Medical therapy of endometriosis has been shown to be
useless, and just wastes time and money because you cannot conceive
while you are taking this “treatment”.
8. Immune therapy for repeated pregnancy losses.
Patients who suffer repeated pregnancy losses present one of
reproductive medicine’s most frustrating problems. We usually cannot
pinpoint the reason for the miscarriage, which means that patients
are often desperate in their search for solutions. They are
emotionally very vulnerable, and are willing to try anything under
the sun, in the hope that it will work for them. They intuitively
believe that their body is “rejecting” their embryos, which is why
immune therapy for these patients has become so popular and
fashionable. Unfortunately, not only is it extremely expensive,
there is no evidence to show it helps. For every patient who has a
healthy baby after taking IVIg after suffering three miscarriages
(and who is considered to be a shining example of the success of
immune therapy) , there are at least another five patients who go on
to have a healthy baby after three miscarriages, with the help of
only TLC – tender loving care !
9. Physical therapy and massage therapy to
remove adhesions. “Clear passage” at www.clearpassage.com claims to
achieve excellent success rates with “site-specific” massage, which
they believe “decreases adhesions and increases function of the
organs.” This is an excellent example of quack therapy ( to learn
how to identify quackery read
www.quackwatch.com). However, it’s all just clever marketing (
what a lovely name they have selected !) . Their claims that their
“medical studies “ were “recently honored with induction into the US
Library of Medicine” will unfortunately mislead naïve patients into
believing that this therapy works, when every surgeon know that it’s
impossible to remove adhesions without surgery – after all, scar
tissue does not melt because you knead it !
Not only do all these treatments waste time,
money and energy, they also cause patients to get fed up and
frustrated, so that they end up losing confidence in doctors - and
in themselves ! The worst kind of hope is false hope – and these
treatment offer unsuspecting patients just that, and nothing else.
The only antidote against this is information and education, so you
can protect yourself from such harmful treatments.
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