Study: Infertility Treatments No Help
Drug Treatment and Intrauterine Insemination May Not Work When Used Separately
Infertility Treatments: Second Opinion continued...
"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."
But the less aggressive, less expensive fertility treatments are worth a try in some women, says Mousa Shamonki, MD, director of in vitro fertilization and assisted reproduction at the University of California Los Angeles Medical Center. For unexplained infertility, the lower-tech options include those evaluated in the U.K. study and also injections of hormones combined with intrauterine insemination, he says.
For other types of fertility problems -- other than unexplained infertility -- Clomid alone may work, Shamonki says. "Clomid works well for women who aren't ovulating [regularly]," he says, such as women with polycystic ovary syndrome. PCOS is a leading cause of female infertility. Insemination alone may work for couples who have mild male-factor infertility or who have a history of cervical surgery, he says.
If none work, IVF techniques can be tried, he says; if couples are running out of time, they may opt to get more aggressive more quickly.
Psychologically, couples can find waiting frustrating, says Michael Diamond, MD, professor of obstetrics and gynecology at Wayne State University, Detroit. "Usually after a year of trying and not succeeding, the last thing a couple wants to hear is 'Go home and try again.'"