Are These Infertility Tests Really Necessary?

The range of tests available for people who are having trouble getting pregnant is ever-growing. But what infertility tests are really necessary?

The American Society for Reproductive Medicine (ASRM) has recently updated their list of infertility tests and procedures that may be unnecessary when evaluating patients. They recommend that a physician and their patient discuss the use of these common but sometimes unneeded treatments before using them. Here is a list of ten tests physicians and patients should question.

1. Diagnostic laparoscopy for the evaluation of unexplained infertility. Routine diagnostic laparoscopy should not be performed unless there is a suspicion of a pelvic abnormality based on patient history or other less invasive tests.
2. Advanced sperm function testing in the initial evaluation of the infertile couple. These advanced sperm function tests (such as Sperm Penetration or Hemizona Assays) have extreme variability and little correlation between their results and treatment outcome.
3. Post-coital testing for the evaluation of infertility. The post-coital test has not been found to be reliable or effective in improving pregnancy rates.
4. Thrombophilia testing on patients undergoing routine infertility evaluation. These tests (such as Antithrombin Antigen or Factor V Leiden mutation) are of no benefit to a patient unless they have a history of bleeding or abnormal clotting disorders.
5. Immunological testing as part of routine infertility evaluation. These tests (such Antiphospholipid Antibody or Antisperm Antibody) are very expensive and do not predict pregnancy outcome.
6. Karyotyping as part of the initial evaluation for amenorrhea. Amenorrhea (absence of menstrual bleeding) can be attributed to many causes. Karyotyping (also known as chromosome analysis) is not a screening test. It would not be indicated unless there are physical findings that suggest a disorder of sexual development or a history of recurrent pregnancy loss.
7. Prescribing testosterone to men planning or attempting to initiate pregnancy. Testosterone therapy is widely used as a treatment for male sexual dysfunction. However, it is well documented that the use of testosterone can lead to decreased or absent sperm production. Furthermore, this effect is not always reversible even after stopping the use of this hormone.
8. Testing women in their 40’s for FSH (follicle stimulating hormone) levels to identify the menopausal transition as a cause of irregular or abnormal menstrual bleeding. After age 40, menstrual bleeding becomes less predictable. As women approach menopause, blood levels of FSH vary greatly from both woman to woman and from day to day in the same woman. Therefore, an FSH level does not predict when menopause will occur or verify that is has begun.
9. Performing endometrial biopsy as a part of a routine infertility evaluation. Endometrial biopsy is the removal of a small piece of tissue from the lining of the uterus for evaluation. In the past, it was used to determine if the lining was adequately developed to support implantation. However, abnormal results are obtained in more than one-third of women who have no difficulty in conceiving, so the test has limited usefulness in evaluating infertility.
10. Performing prolactin testing as part of the routine infertility evaluation in women with regular periods. There is no reason to expect that a woman would exhibit a clinically significant elevated prolactin level, if they have a normal menstrual cycle and no evidence of galactorrhea (milky discharge from breast). Therefore, prolactin testing would probably provide no benefit in these patients. This one is a bit puzzling. We have several IVF/ ovulation induction patients with regular cycles and no galactorrhea that have elevated fasting prolactin levels. Elevated prolactin levels do have a negative impact on implantation. We therefore continue to measure prolactin levels in these patents.

If your doctor recommends any of the assessments mentioned above, talk to them about their reasons for doing so. In this way, you can be certain that you are receiving the best of care, and avoiding the cost and wasted effort of unnecessary testing.

To see a Board Certified physician who is qualified to help you decide which infertility tests and procedures are right for you, make an appointment at one of InVia’s four Chicago area fertility clinics.