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Health » Sexual-health » Harmful-infertility-treatments-060515
 
Protect yourself against harmful infertility treatments - Part I

Dr. Aniruddha Malpani Dr. Aniruddha Malpani
Renowned infertility specialist. He runs an infertility clinic in Mumbai and has written many books.

Protect yourself against harmful infertility treatments
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?

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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 creates 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 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 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 an 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).

click here to read Harmful infertility treatments - Part II »

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