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New doubts raised about common fertility treatments PDF Print E-mail
A new study raises new doubts about treatments offered all-too-frequently to couples with unexplained infertility, a diagnosis given to about one in eight infertile couples. The study, published in the British Medical Journal, compared two common treatments with the wait-and-see approach.

Couples with unexplained infertility were randomly assigned to have ovarian stimulation with clomiphene citrate (otherwise known as Clomid) or to have intrauterine insemination (IUI) without ovarian stimulation drugs. A third group was encouraged to try to get pregnant but were not given any treatment.  Researchers found no significant difference in pregnancy rates among the groups.

 Women who had no intervention had a live birth rate of 17 percent, the group taking Clomid had a birth rate of 14 percent, and the group having IUI alone had a birth rate of 23 percent. Though the rate is higher in the IUI group and lower in the Clomid group, the differences were not statistically significant. Another way to think of it is that the treatments were not successful enough to justify their costs--emotionally, physically and financially.

In truth, this study really questions the way these common first-line techniques were used and the failure to diagnose. Unexplained infertility is the diagnosis assigned to about one in eight infertile couples whose tests have been inconclusive as well as those that have not completed a thorough evaluation. This study confirms what we know about infertility and what we say in our book, Perfect Hormone Balance for Fertility.

There are a lot of well intended but inappropriate infertility treatments offered just to satisfy the "do something" mentality. The desire to fix problems with medical interventions is powerful--in both doctors and patients. The authors of the study pointed out that the couples who did nothing were the least satisfied with their treatment, even though their treatment was equally effective.

There is nothing wrong with using Clomid appropriately, but it should be used much more judiciously than it is today. The problem is, Clomid can promote egg production by the ovary while also reducing the ability of sperm to reach the egg. It can also reduce the ability of the uterus to support the implantation of an embryo. Patients should be carefully monitored with ultrasound to make sure it is promoting ovulation and not overstimulating the ovaries, which could increase the risk of high multiples—triplets, quadruplets, and beyond.

The other procedure, IUI alone, is simply performing an office based insemination during the woman's ovulatory period. It is not recommended in most situations since we now know that many eggs are genetically abnormal so simply improving the opportunity for sperm to reach them isn’t going to overcome most infertility problems. The bottom line is that today’s fertility treatment should be individualized for each couple rather than simply writing a prescription or performing a procedure.