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    Study: Infertility Treatments No Help

    Drug Treatment and Intrauterine Insemination May Not Work When Used Separately

    Comparing Infertility Treatments

    At the study's end, 32 women (17%) in the no-treatment group had given birth, compared to 26 (14%) in the medication group and 43 (23%) in the insemination group.

    More women who got either the insemination or the medication found the process more acceptable than those who got no treatment, the researchers found.

    Bhattacharya believes his team is the first to compare the treatments in this way. "Most people have compared treatment A with treatment B."

    "Although it may seem a bit counterintuitive, this is the one area of medicine where doing nothing could be as effective as going for any of these treatments," he says.

    The researchers write that the findings challenge current practice in the U.K., with recommendations now favoring what they found ineffective -- insemination without stimulation by a medication and lower doses of the ovulation-inducing medication to decrease the risk of multiple pregnancies.

    The study is published in Online First at bmj.com.

    Infertility Treatments: Second Opinion

    In an editorial accompanying the study, experts from the Assisted Conception Unit at Guy's and St. Thomas' Hospital NHS Foundation Trust in London write that treatment should be individualized, taking into account the woman's age, the duration of infertility, and other factors.

    While U.S. experts point out that they generally use ovarian stimulation and intrauterine insemination in combination, the editorial authors point to a study, published in The Lancet in 2006, that questions the benefit of even the combination treatment compared with no treatment.

    They conclude that the generally higher-tech option, in vitro fertilization -- in which eggs and sperm are fertilized in the lab, and then the embryo is implanted in the uterus -- may be the most cost-effective option.

    Treatment approaches differ in the U.K. and U.S., says Donna Session, MD, chief of the division of reproductive endocrinology and fertility and associate professor of obstetrics and gynecology at Emory University School of Medicine in Atlanta. "In the U.S., generally higher doses [of Clomid] are used, typically 100 milligrams a day." And medication and insemination are typically combined.

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