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Patients with unexplained infertility often find it
very difficult to accept this diagnosis, and their commonest plaint is -
I wish I knew why I wasn’t getting pregnant. They are also not sure how
to proceed – “After all, if the doctor cannot find out what the problem
is , how will he be able to fix it ? “
Unfortunately, they are so focused on trying to find
out what the problem is they often get paralysed into inactivity . Since
they do not get any clear answers , they keep on doctor shopping. This
increases the confusion, because they get widely varying opinions and
treatment options, so that they don’t know what to do next. ( By
contrast, for a woman with damaged , blocked tubes, the absence of
alternatives makes decisions making easier ! They only have 3 choices –
remain child-free; adopt; or do IVF).
Unfortunately people get so obsessed with diagnosing
problems so that they can fix them, that they end up doing a zillion
investigations, and identifying millions of minor irrelevant problems,
which have no bearing on the fertility problem. However, they
concentrate their energies on correcting these so called problems (
whether it’s pus cells in the semen; minimal endometriosis; high levels
of NK cells , an abnormal SCSA result, or whatever) that they lose sight
of the important goal, which is a baby ! It’s important to focus your
energies on your goal, so you don’t waste time and energy or
irrelevancies.
It is interesting to see how fashions in medical
science also change with regard to these patients . For example , many
years ago , the diagnosis of luteal phase defect was very commonly
invoked, and this was a very popular diagnosis to explain the
infertility in some of these couples and many investigation protocols
and treatment protocols were also designed to treat this “problem “.
After all, doctors , just like patients, are happier when they have a
name to put on a particular disease .
The problem with treating unexplained infertility is
that anything can work , which is why there are so many anecdotal
successes with all forms of treatment. Since infertile couples are
emotionally very vulnerable , they are often willing to try any
treatment fad , in the hope that it’ll work for them.
Also since everything is “normal” , many of these
couples are hell-bent on achieving a natural pregnancy in their own
bedroom. After all if everything is normal , then there really is no
reason why they can't get pregnant in their own bedroom, is there ? And
all of us have heard success stories of people who have conceived after
ten to fifteen years of trying . Unfortunately , these couples often end
up wasting a lot of precious time . The fact remains that if people
haven’t got pregnant in their own bedroom within three years of trying ,
the chances of their conceiving on their own are very low. It is no
longer cost effective or time effective for them to keep on waiting ,
because they pay a price for this waiting – and the price they pay is a
loss of their reproductive potential. This often means that by the time
they seek infertility treatment , there is little an infertility
specialist can offer them .
I always remind my patients with unexplained
infertility that the quality of the answer depends on the quality of the
question , and the question should NOT be – “Why am I not getting
pregnant ?” After all , no one cares about problems - people only care
about solutions ! The right question is – “ What can I do in order to
get pregnant ?” Rather than waste time and money on irrelevant tests ,
it's important to formulate a treatment plan of action to maximize the
chances of success . Never do a test or investigation if it does not
change your treatment plan !
The good news is that even though our medical
technology for diagnosing problems in the area of infertility is not
very good , our technology for solving them today is brilliant .
This is the reason why IVF is such an effective
treatment option for patients with unexplained infertility – it allows
us to bypass all the possible barriers to the eggs and sperm meeting
within the human body – even if we cannot name these barriers , or come
to an “accurate diagnosis “ in the individual patient. I remind my
patients that IVF allows us to do in the lab what should normally have
happened in their bedroom , and is not happening because Nature has let
them down . We still may not be able to pinpoint where Nature has let
them down , but once they have a baby in their hands , this then
becomes a question of merely academic interest .
This success-oriented approach to infertility means
we need to turn the conventional medical principle of making a diagnosis
and then deciding the correct treatment upside down, but it’s easier to
understand this approach by looking at a simple analogy. Suppose you
want to go from Boston to New York, and your car breaks down half-way.
One option is to take the car to the garage , let the mechanic diagnose
the problem, and then let him fix it. The other option, which is much
better if you are in a hurry, is to just take another car and drive it
down to New York. The important this is to reach New York – how you get
there is really not important ! Similarly, as long as IVF allows us to
bypass the medical problem ( even if we don’t know what the problem is
and we can’t put a name to it), and allows patients to get the baby they
want, then it makes much more sense to go in for IVF, rather than waste
time on testing , and fixing minor and often irrelevant problems.
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