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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 typically combined.

"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 of pregnancy."

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 become pregnant.

"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 this study."

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