Tests and Treatments That Never Worked: The Infertility Edition
We scraped the uterus to help women conceive. We blew air through their tubes. We gave them clomiphene without watching what happened. We transferred four embryos when one would have worked.
We tested the mucus the morning after sex. None of it improved outcomes.
Infertility affects approximately 10-15% of couples. The desire for a child is among the most powerful human motivations. When medicine promises to help, patients will accept almost any intervention, however unproven, however uncomfortable, however expensive.
This vulnerability has made the infertility field particularly susceptible to the persistence of unvalidated practices. When a woman who has been trying to conceive for two years is offered a diagnostic D&C, or a postcoital test, or unmonitored clomiphene, she does not ask for the Cochrane review. She says yes.
The five practices in this post share a common feature: each was performed routinely for decades despite an absence of randomized evidence demonstrating benefit. Some were diagnostic tests that did not predict outcomes. Some were treatments based on plausible mechanisms that failed when tested. One, high-order embryo transfer, worked too well: it achieved pregnancies at the cost of a multiple pregnancy epidemic that caused thousands of premature births.
🎯 Free Subscriber Bottom Line: Five routine infertility practices have been abandoned or fundamentally reformed: diagnostic D&C to “enhance” fertility, tubal insufflation (the Rubin test), clomiphene citrate without ultrasound monitoring, high-order embryo transfer in IVF, and the postcoital test. Each was performed for decades without randomized evidence of benefit. The postcoital test had no predictive value. High-order embryo transfer caused the iatrogenic multiple pregnancy epidemic. Each consumed time, money, and emotional resources from couples who deserved evidence-based care.
Below, paid subscribers get: - The “endometrial scratching” myth and why D&C doesn’t improve fertility - The Rubin test: blowing air through fallopian tubes in the office - Unmonitored clomiphene and the multiple pregnancy disaster - The evolution from 4+ embryos to single embryo transfer: the data that changed IVF - The postcoital test: the most useless test in reproductive medicine - How the infertility industry’s incentive structure sustains unvalidated practices.
