If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Common Infertility Treatments Are Unlikely to Improve Fertility LONDON -- August 7, 2008 -- Long-established medical interventions to help couples with infertility problems do not seem to improve fertility, according to a study published online in the BMJ (British Medical Journal). These findings challenge current practice in the UK and national guidelines should be reviewed in the light of this evidence, said the authors. A team of researchers led by the University of Aberdeen, Aberdeen, United Kingdom, compared the effectiveness of 2 specific interventions with no treatment. They recruited 580 women who had experienced unexplained infertility for more than 2 years from 4 teaching hospitals and a district general hospital in Scotland. The women were randomised into 3 groups. The first group was encouraged to try naturally for a pregnancy and had no medical interventions. Another group took oral clomifene citrate (CC), and the third group 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 taking oral CC had a birth rate of 14%, the group having unstimulated IUI had a birth rate of 23%, and the group with no interventions had a live birth rate of 17%. 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 6% 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 10% of women. Interestingly, women on active treatments were reassured by the process of treatment while women who had no interventions were less satisfied, despite it being equally effective. "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." In an accompanying editorial, Tarek El-Toukhy, MD, and Yacoub Khalaf, MD, from the Assisted Conception Unit at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, said: "As a direct result of the lack of evidence, many couples with unexplained infertility endure expensive, potentially hazardous, and often unnecessary treatments." They call for high-quality clinical trials to guide policymakers and to inform patients about the best treatments, and the cost effectiveness and the adverse effects associated with these interventions. In addition, they suggest that current National Institute for Health and Clinical Excellence (NICE) guidelines, which endorse the use of up to 6 cycles of IUI without ovarian stimulation in couples with unexplained infertility, be reviewed in the light of current evidence.
SOURCE: BMJ (British Medical Journal)
|
