Two infertility treatments found to be no better than nature

Two common infertility treatments are no more effective than trying to conceive naturally, according to a study published in the British Medical Journal. The study looked at the effectiveness of taking the drug clomifene citrate (CC) or having intra-uterine insemination (IUI) versus no intervention, and found that live birth rates were not significantly different.

The research was led by Professor Siladitya Bhattacharya of Aberdeen University, and studied 580 women who had experienced unexplained infertility for more than two years. The women were randomly placed into three groups - one group were encouraged to try naturally for a pregnancy and had no medical interventions; one took oral CC which is believed to correct subtle ovulatory dysfunction; and one had IUI, which is thought to enhance the chance of pregnancy by injecting sperm behind the cervical barrier. All treatments were followed for six months.

At the end of the study there had been 101 live births. Seventeen per cent of the women who were advised to conceive naturally gave birth, compared to 14 per cent of those who were taking CC and 23 per cent of those who had IUI. The study concludes that the interventions did not significantly alter the chances of having a live birth compared to having no treatment. In addition, 10 per cent of the women taking CC experienced unpleasant side effects including abdominal pain, bloating, hot flushes, nausea and headaches.

One in seven couples in the UK experience problems conceiving and, in a quarter of these cases, the infertility is unexplained. The National Institute for Health and Clinical Excellence (NICE) issued guidelines four years ago which endorses the use of up to six free cycles of IUI without ovarian stimulation, for couples with unexplained infertility. The researchers suggest the NHS could be wasting money on such treatments and call for the guidelines to be reviewed.

In an accompanying article, Tarek El-Toukhy and Yacoub Khalaf from the Assisted Conception Unit at Guy's and St Thomas's NHS Foundation Trust Hospital in London wrote: 'As a direct result of the lack of evidence, many couples with unexplained infertility endure (and even request) expensive, potentially hazardous, and often unnecessary treatments'.