Study: Infertility Treatments No Help
Drug Treatment and Intrauterine Insemination May Not Work When Used Separately
Comparing Infertility Treatments continued...
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
"If anything, the take-home point from this study is, in the group where
they did insemination alone -- without any fertility drug -- there
wasn't a significant increase in pregnancy,'' she tells WebMD. "Just doing
insemination alone is probably not going to really increase a person's chance
Individualizing treatment recommendations is important, she says, taking
into account a woman's age and other factors such as "ovarian reserve"
testing to evaluate the quality of the ovaries and how likely a woman is to
"If you have a patient with good results on the ovarian reserve testing,
then expectant management [no treatment] might be something the patient might
desire," she says.
The results particularly don't apply to U.S. women if they are treated by a
fertility specialist, says Tracey Telles, MD, chief of reproductive
endocrinology and infertility at the Kaiser Permanente Diablo Service Area
in Walnut Creek, Calif. "In the United States, the indication of
unexplained infertility is definitely managed more aggressively than it was in