Abuse
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we are in need to describe investigations for our patients but over prescription of these investigations especially if unnecessary could be considered abuse
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Abuse
- 1. Use & Abuse Of Infertility Tests Model of Endometrial receptivity
- 2. 1 •Introduction 2 •Root causes 3 •How to combat ?
- 3. ????
- 5. Since 2014 available data do not support an association between aPL and infertility, and aPL positivity does not seem to influence IVF outcome.
- 6. ViT D assay
- 7. Beneficial
- 9. Impact of Inappropriate Lab Utilization Financial Burden Medical Unnecessary blood draws Phlebotomy acquired anemia . Increased Costs Patient? Center ? Likelihood of false-positive results
- 10. 1 •Introduction 2 •Root causes 3 •How to combat ?
- 12. Up to 50% Fee incentive
- 13. TORCH for RPL Lack of Knowledge
- 14. More is Safer Defensive Medicine
- 17. Does PGS help increase pregnancy rate in IVF? 1 7 Moniek Twisk et al., Hum Reprod; 20013
- 18. • Cost-effectiveness analysis of PGS and IVF versus expectant management in patients with unexplained recurrent pregnancy loss Unexplained RPL, IVF/PGS with 24-CCS (232)and expectant management (302) Main Outcomes Measure(s):Cost /LB. Result(s): LBR and miscarriage were 53% and 7%. IVF/PGS and 67% and 24% in expectant. PGS 100-fold more expensive, $45,300/LB compared $418/LB with expectant. Conclusion(s):IVF/PGS not cost-effective. LBR with IVF/PGS needs to be 91% to be cost effective compared with expectant. Murugappan, et al., Fertility Sterility, 2015
- 19. 1 •Introduction 2 •Root causes 3 •How to combat ?
- 20. Practical Steps to combat the problem Diagnostic Algorithms Evidence Based Cost effectiveness System Approach
- 21. Abnormal sperm count Normal sperm analysis, eugonadal No tests are required Measure testosterone, gonadotrophins, and Prolactin Testosterone Gonadotrophins Testosterone Gonadotrophins Testosterone Prolactin Diagnostic approach for man History & examination Primary testicular failure Hypogonadotrophic hypogonadism: due to hypothalamic-pituitary disease Hyperprolactinaemia: rare
- 22. History & Examination Amenorrhoea, Oligomenorrhoea Normal menses ?Ovulating Measure [Progesterone] in day 21 (mid luteal) Perform pregnancy test Further tests indicated + ve Measure [LH], [FSH], & [Prolactin] High FSH. (+ LH) >30nmol/L <10nmol/L Ovarian failure Ovulating Not ovulating No further tests required -ve High LH Low FSH PCOS High Prolactin Further investigate hyperprolactinaemia All Normal Diagnostic approach to anovulatory woman
- 23. E.R can not be accurately predicted
- 24. Commercially available without evidence the ERA test (Endometrial Receptivity Array) : a customized array based on the expression of 238 genes coupled to a computational predictor capable of diagnosing a functionally receptive endometrium.(Diaz-Gimeno P et al.,2011)
- 25. - Recurrent implantation failure - Single embryo transfer (sET). (Barzilay Eran et al.,2018) - endometrial biopsy must be performed at P+5 (hormone replacement therapy cycle) or at LH+7 (natural cycle) Invasive
- 26. But • No RCT have been conducted • Commercially propagated without clear evidence • Very expensive
- 27. Question • Why to jump from research to practice without evidence? • Who pay for it ? • Does it really improve pregnancy rate?
- 28. Let’s achieve More with Less
Notas do Editor
- Example: If test probability is only 1% and the test is false positive result can mislead the diagnosis. Or Thyroid profiling in a ICU patient give false results.