Tests that should not be ordered routinely
The fertility society publishes a list. Several items on it are sold widely.
The evaluation document prints its own list of tests that should not be ordered routinely unless there is a specific reason. Reproduced as printed:
| Tests named on the do-not-order-routinely list |
|---|
| Laparoscopy for unexplained infertility |
| Advanced sperm function testing, for example DNA fragmentation testing |
| Postcoital testing |
| Thrombophilia testing |
| Immunologic testing |
| Karyotype |
| Endometrial biopsy |
| Prolactin, progesterone, estradiol, follicle-stimulating hormone, luteinizing hormone |
The document repeats the point in its conclusion. Laparoscopy, advanced sperm function testing, the postcoital test, thrombophilia testing, immunologic testing, karyotype, endometrial biopsy and serum prolactin are all named there: none of them belongs in a routine evaluation without another clinical reason to order it.
Two of these are worth expanding, because they are still offered:
Endometrial biopsy to date the lining. Dating the lining under a microscope is not a valid way to tell whether you ovulate. It is not accurate, it does not give the same answer twice, and it cannot tell a fertile woman from an infertile one. The document is blunt: careful studies have since demonstrated that histologic endometrial dating is not a valid diagnostic method for ovulatory function because it lacks both accuracy and precision and cannot distinguish fertile from infertile women.
The postcoital test. The document gives five reasons in a single sentence: it is subjective, it does not give the same answer twice, it is inconvenient for the patient, it rarely changes what anyone does, and it does not predict whether you will conceive. In full: The postcoital test is no longer recommended for the evaluation of infertile women because it is subjective, has poor reproducibility, is inconvenient to the patient, rarely changes clinical management, and does not predict inability to conceive.