As we all are aware, infertility tests often 1) Need to be timed based on time of the menstrual calendar, 2) Are expensive and sometimes painful, 3) Repetitive , and 4) Not often covered by insurance. So if this is the case, they should be helpful.
Let’s examine some and see how good they are:
- Postcoital Testing. In this test, the woman comes to the office after intercourse. A portion of cervical mucus is passively removed and examined under the microscope for the amount of spinnbarkeit (stretchiness), the number of motile sperm, whether there are white blood cells, and whether ferning is apparent. Guess what? The test has no predictive value. I published a paper while at University that showed whether 10 to 20 motile sperm were seen, or no sperm were seen, had no bearing on pregnancy rates.
- Antisperm Antibodies. Antisperm antibodies require an immunobead test to be performed. It requires sperm to swim through the antibody media and pick up antibodies to the sperm head, neck or tail. This test was most common in men with vasectomy reversal, but was not predictive of pregnancy. Also, women might have antibodies in their blood, but does that mean they had them in their genital tract? As a result, the test has been abandoned and instead intracytoplasmic sperm injection (ICSI) is performed if persistent male factor appears a factor.
- Diagnostic Laparoscopy. Ever wonder why this is rarely performed any more in the evaluation of infertility? Mainly because it had poor utility in picking up problems like endometriosis that might impede conception. One study suggested that eight laparoscopies were needed to pick up one case of endometriosis that might be treated and have an impact of the couples chance of conception. Now, if the hysterosalpingogram (HSG) is abnormal, especially in the setting of painful periods, then laparoscopy is warranted.
- DNA Fragmentation Testing of Sperm. This test can be performed to determine whether the DNA in the head of the sperm is out of alignment and broken. If the DFI, or index for fragmentation exceeded 30, then it was felt that IVF with ICSI would be necessary for fertilization and conception. We have had an excellent pregnancy rate in couples with a DFI above 30. Hence we no longer order this test.
There will be other tests that will be espoused as valuable by certain health care providers. Opinions will continue to differ on the utility of many of these. I have just named a few that seem less helpful than they did when they were first introduced.