I am going to continue with the response to questions for a bit more. This time I will start with the most recent and work backwards. Here I will address the SCSA question. I will continue to get to the other questions as the blogs roll out.

The SCSA: I do not order this test. Maybe someday I will, but I need more science. When a new test comes out (I know it’s been out for years, but it’s relatively new and not universally performed), there are a few reasons that it becomes popular.

One is that it is a great test and can really distinguish between who is fertile and who is not. Another reason is that some company is making tons of dough and can afford to spend a lot of money convincing your doctor this is a must do test. Another is that some doctors do some quick and dirty research, making a case for the test thus boosting their careers. Another is that some famous doctors are on the boards of these companies, and they use their international reputations to convince other doctors it’s a good test. Another reason is that in order to keep up with the competition, you doctor needs to order the test, even if he does not believe in it, so that you will not leave him and go to the doctor who orders the test. Another reason is that when anything new comes out there is a quick flurry of studies showing its good, but it takes years for studies to come out against. When something is new, a lower quality of research suffices for publication, whereas the standards of publication go up over time. There are probably others.

Now I never said the first reason did not apply to the SCSA, but as you can see other reasons need to at least be considered.

I can say one of the tests sales people came to my office last week and started to tell me about the test. He said the test has clearly been shown to distinguish between the fertile and infertile. I said show me the data and he said it’s not published yet. I thought how strange, you have been selling this test for years, and you are telling me it’s a must do, and yet you can’t show me any data?

I do see that a woman wrote in saying the test helped her. I am very happy about this. The universal question is, if she did not have the test, would her course of therapy have changed?

Why does this matter to me? So what if you get one extra test? Because what if the sperm is actually good, and someone tells you the SCSA says the sperm is bad? What if you don't need IVF, or you don't need ICSI, or you don't need to adopt? That's the issue: giving people erroneous bad news. At NYU, like most good centers, we have been doing just fine without the test. Men with low counts have lower natural pregnancy rates, and may need IVF with ICSI, or even biopsies. But almost every fertility doctor has pregnanies from men with alomst no count, almost no motility and hideous morphology. Can we really tell anyone to give up based on this test, or any test? This test better be perfect, and few things are perfect.

I am going to sign off now. After I get to some more of the questions I will get back to you about this.
I will contact the company again and search the medical data base for some hard published data.

Dr. Licciardi