Study: Infertility Treatments No Help

Two common infertility treatments do not improve fertility, according to a study conducted in the U.K.

Researchers looked at drug therapy to induce fertility and no treatment. In addition, they compared intrauterine injections (in which the sperm enter the uterus in order to fertilize) with no treatment. The researchers only looked at couples who were experiencing infertility that was not explained by any other reason.

Siladitya Bhatarya MD, who is also a leading author of this study and a professor of reproductive medicine at Aberdeen University in Scotland says, "What we discovered was that none of these commonly used treatment offered a higher rate of birth than any other." "We have proven that no of these first-line therapies is superior to [the couple] trying it themselves.

Live births were 17% in the group without treatment, 14% in the group with medication, and 23% in the group with insemination. Bhattacharya told WebMD that there were no differences in the rates of live births.

U.S. fertility professionals who examined the study for WebMD said the findings are likely to have limited relevance for infertile couples in America with unexplained impotence. The two infertility therapies -- each being compared individually and none of them in the U.K. studies -- are usually used here in combination. Also, the U.K. study used a lower dose of medication than is usual in the U.S.

The availability of infertility treatments is limited

Bhattacharya and 580 infertile females, each on average 32 years old, were recruited by his team from five hospitals in Scotland. They randomly assigned them one of three groups.

One 50-milligram dose of Clomid was administered to each participant. If the Clomid dose overstimulated the female ovaries, it was decreased to 25 milligrams. The women were advised on the most appropriate times for intercourse. Women in the intrauterine Insemination Group monitored their hormone levels. Sperm were then placed into the uterus when conditions warranted. In the no-treatment group, women were given advice on how to maintain regular intercourse throughout the six-month period. The women were all trying to conceive naturally for at most two years. Unexplained Infertility is when doctors fail to identify abnormalities following tests, such as semen analysis or evaluation of the fallopian tube. According to researchers, about one in seven couples is infertile. About 25% of the people experiencing unexplained fertility are also infertile.

Comparison of Infertility Treatments

After the study was over, the number of births had increased to 32 (17%) for the no-treatment group, as compared with 26 (14%) in the medication group, and 43 (23%) for the insemination.

The researchers discovered that more women who had insemination and/or medication found it acceptable than those who didn't.

Bhattacharya thinks his team is the one to have compared the treatments this way. "Most people have already compared treatment A to treatment B."

"While it may sound counterintuitive, there is one area in medicine where not doing anything could prove as beneficial as going to any of the treatments," he said.

Researchers write that their findings are challenging current U.K. practice. They recommend insemination with no stimulation and low doses of ovulation-inducing medications to reduce the chance of multiple pregnancies.

The article is available online in Online First on bmj.com

The Second Opinion on Infertility Treatments

The Assisted Conception Unit at Guy’s and St. Tom's Hospital NHS Foundation Trust in London writes in an editorial, that each woman should receive treatment according to her age, infertility length, and other variables.

Experts in the United States insist on using ovarian stimulation with intrauterine Insemination together. However, The Lancet published a 2006 study that questioned the benefits of any combination therapy.

In vitro fertilization, which involves the use of eggs and sperm in a lab to fertilize the egg and implant the embryo in the uterus, is generally considered the best option.

The U.K. has different treatment approaches, according to Donna Session MD, Chief of the Division of Reproductive Endocrinology and Fertility and Associate Professor of Obstetrics at Emory University School of Medicine, Atlanta. Clomid doses in America are generally 100mg per day. Combining medication with insemination is common.

She tells WebMD that "If anything, this study shows that in the group who did only insemination -- with no fertility drugs -- there was not a significant increase of pregnancy." The chances of getting pregnant by insemination is not likely to be increased by doing it alone.

It is essential to individualize treatment recommendations, says she, by taking into consideration a woman’s age as well other factors, such "ovarian reserve testing" to determine the quality of the eggs and whether a woman is likely to get pregnant.

She says, "If you can get good results from the ovarian reserve test, expectant management [no treatment] may be an option for the patient."

These results are not applicable to U.S. females if the fertility specialist treats them, according to Tracey Telles MD, chief reproductive endocrinology at Kaiser Permanente Diablo in Walnut Creek.

Mousa Shamonki MD is the director of assisted reproduction and in vitro fertilization at University of California Los Angeles Medical Center. However, some women may find the cheaper, more aggressive fertility treatments worth trying. He says that the best options for undiagnosed infertility are those from the U.K., as well as injections of hormones with intrauterine fertilization.

Shamonki suggests Clomid as an option for fertility problems other than unexplained. Shamonki says Clomid is effective for those women who do not ovulate [regularly]." He also mentions that Clomid can be used to treat polycystic or polycystic syndrome patients. PCOS is the leading reason for female infertility. He says that insemination may be possible for those who are experiencing mild to moderate male-factor fertility or have had cervical surgery.

IVF methods can be used if they fail. Couples who are short on time may choose to become more aggressive.

Michael Diamond MD, professor of Obstetrics and Gynecology, Wayne State University, Detroit, said that waiting is often frustrating to couples. The last thing that a couple needs to hear after one year of failing and trying again is "Go home, try again."