Center for Assisted Reproduction
What is MaxTest?
MaxTest© is a comprehensive evaluation designed to make the most accurate diagnosis of the cause of infertility in the shortest time frame?
How does MaxTest© differ from traditional diagnostic testing?
The clinicians at the Center for Assisted Reproduction are some of the most highly trained and respected infertility specialists in the country. The four physicians have a combined 50 years in practice diagnosing and treating infertility. The diagnosis of infertility has traditionally followed an algorithm based approach. The tests most likely to find a cause for infertility are conducted first. Testing for less likely causes is deferred. If initial testing is unable to disclose a cause or if initial treatments are unsuccessful, more comprehensive testing is performed.
What are the advantages of the traditional approach?
In some cases, the cause of infertility can be diagnosed accurately with only a few tests. For these couples, appropriate treatment can be initiated promptly and the cost of evaluation may be less than with a more comprehensive approach.
What are the disadvantages of the traditional approach?
For many patients, the true cause of infertility cannot be easily established with preliminary testing. Preliminary testing may not reveal a cause or may reveal only one of multiple contributing causes. With the traditional diagnostic approach, this can lead to inaccurate or delayed diagnosis. These patients will require additional testing or, worse, may undergo treatments unlikely to achieve pregnancy. Ultimately, the cost of infertility care may be increased and the likelihood of pregnancy decreased.
What are the advantages of MaxTest?
The advantage of MaxTest© is that a comprehensive set of tests are bundled together to allow the fastest, most accurate diagnosis of the cause of infertility. Because the evaluation is extremely rigorous, the likelihood of misdiagnosis or an incomplete diagnosis is limited.
How does the cost of MaxTest© compare to the traditional approach to diagnosing infertility?
Because the MaxTest© philosophy is to employ the most comprehensive set of tests currently available, the cost of diagnosis may be more than with the traditional selective algorithm based "a la carte" approach. Despite this, because we are able to efficiently bundle services and billing, the cost of diagnosis for many or even most individuals can be significantly reduced. Additionally, since inappropriate or ineffective treatments may be more easily avoided, we believe that the savings related to treatment will more than offset any increase in the cost of diagnostic testing.
What are the components of MaxTest?
The cause of infertility can be grouped into three main categories: 1) male factors, 2) female anatomical factors and 3) ovarian dysfunction / endocrine disorders in the female. MaxTest© is designed to evaluate fully each of these broad categories.
What individual tests are included to diagnose male factors?
The American Society of Reproductive Medicine and American Urologic Association recommend two semen analyses even if the first analysis is normal. The algorithm based method traditionally would not repeat semen testing if the first specimen is within the normal range. The purpose of the testing is to improve the sensitivity of the testing (reduce the rate of false negatives). Two tests are done under MaxTest© Male. Testing of sperm morphology is particularly prone to variance in testing. We do all semen analyses (including morphology) with a "high tech" computerized system. If one test of morphology is abnormal and the second is normal, we will repeat the testing for confirmation at no additional charge. Hormonal testing in the male can also be important both for diagnosis and treatment of male infertility. A panel of blood tests designed to evaluate the male (Testosterone, TSH, Prolactin, LH and FSH) are included in the MaxTest© Male. Immunologic male factor (sperm antibodies) can be present both in males and females. This testing is also included. Finally, in the last few years, numerous studies have indicated that a genetic issue (DNA fragmentation) is a cause of infertility. This, like sperm antibodies, cannot be detected upon traditional (even computerized) semen analysis. This testing is included.
What individual tests are included to diagnose female anatomical factors?
The pelvic examination and 3D pelvic ultrasound examination performed at the initial visit are excellent initial tests for female anatomical factors. Unfortunately, despite the good information that can be obtained, the sensitivity of these exams is inadequate. Significant structural / anatomical problems can go undetected. The "gold standard" for evaluation of the female reproductive anatomy are laparoscopy (an operative procedure involving general anesthesia in which a fiberoptic telescope is placed through an incision in the naval) and hysteroscopy (a procedure in which a fiberoptic telescope is placed through the cervical canal to visualize the uterine cavity). We have sought to balance the need to make an accurate diagnosis with the desire to minimize the invasiveness of testing when designing MaxTest© Female. Although we do believe that laparoscopy remains a tremendously valuable tool, because it is invasive, we do not believe that it should be performed if the cause of infertility appears to be caused by male factor or ovarian dysfunction / endocrine problems. For this reason, the panel of tests to evaluate the female anatomy does not include laparoscopy, but does include other very sensitive and specific diagnostic tests. These tests do include hysterosalpingography (a great test to check to see if the fallopian tubes are blocked), and diagnostic hysteroscopy (the gold standard for evaluation of the uterine cavity).