One in seven couples in the UK experience infertility. Unexplained infertility affects a quarter of these couples and common interventions to help them have been used for many years in line with fertility guidelines issued by the National Institute for Health and Clinical Excellence (NICE).
A team of researchers led by the University of Aberdeen compared the effectiveness of two specific interventions with expectant management (no treatment). They recruited 580 women who had experienced unexplained infertility for more than two years from four teaching hospitals and a district general hospital in Scotland. The women were randomised into three groups—one group of women were encouraged to try naturally for a pregnancy and had no medical interventions; one took oral clomifene citrate (CC) which is believed to correct subtle ovulatory dysfunction; and the other had unstimulated intra-uterine insemination (IUI) of sperm.
Overall, 101 women became pregnant and had a live birth during the course of the study. The researchers found that women who had no interventions had a live birth rate of 17 percent, the group taking oral CC had a birth rate of 14 percent, and the group having unstimulated IUI had a birth rate of 23 percent. They point out that to have a meaningful and significant improvement in the live birth rate, the difference in live births between unstimulated IUI and no intervention would have to be much higher than the six percent reported in this trial.
Side effects for women including abdominal pain, bloating, hot flushes, nausea and headaches were highest in women taking oral CC, affecting ten to 20 percent of women. Interestingly, women on active treatments (CC and IUI) were reassured by the process of treatment while women who had no interventions were less satisfied, despite it being equally effective.
The researchers conclude: “These interventions, which have been in use for many years, are unlikely to be more effective than no treatment. These results challenge current practice, as endorsed by a national guideline in the UK.”
MEDICA.de; Source: British Medical Journal