Testing for “more information” isn’t always the “best” way, especially when test results aren’t reliable. The field of reproductive endocrinology and infertility, as far as medical fields are concerned, is a young discipline. As a result of the field’s emphasis on research, we are a rapidly growing and expanding. This has resulted in significant advancements in both safety and advancements in success rates for patients. However, as patients and providers eager to continue to improve outcomes, testing and treatment modalities have been implemented into everyday care long before their utility has been justified and validated. This has resulted in increased cost of care, poor quality information and expensive treatment modalities that after implementation have been shown to not be useful or may even impair outcomes.
It is very important for your physician understand not only what a test is looking for, but also how trustworthy (or valid) the test is. Additionally, it is important to have a working understanding of the range in which the test is accurate, how the test is performed and most importantly, what to do when the test is resulted and how to identify potential errors.
One of the most recent examples of care that was implemented before appropriate validation is the use of endometrial receptivity assay’s (ERAs). ERA’s are test which was intended to identify the optimal timing for implantation of an embryo. However, two recent randomized controlled clinical trials (by Doyle Et Al), and a secondary analysis of the first have really put to rest the use of ERAs for the general population. These studies have shown no benefit in ongoing pregnancies with the use of ERA’s. In fact, a secondary analysis of the JAMA study “Effect of Timing by Endometrial Receptivity Testing vs Standard Timing of Frozen Embryo Transfer on Live Birth in Patients Undergoing In Vitro Fertilization: A Randomized Clinical Trial” showed a 10% decrease in live birth rate when the data was analyzed to determine validity of using an ERA as a test. While this data has not been specifically studied in patients with recurrent implantation failure or patients with recurrent pregnancy loss, these findings call question to its utility and are very convincing that the general population will be unlikely to benefit from this test.
These findings are coming after many years of ERA’s implementation into practice. Furthermore, because this testing was not appropriately validated, patients may have inappropriately had the timing of their transfer adjusted based on their ERA with the potential for worse outcomes than with standard protocol. This is one recent example which highlights the importance of understanding testing and how more testing is not always better. If the information we get from tests is inaccurate, then the test can actually be harmful not helpful.
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