Common infertility treatments are unlikely to improve fertility

August 8, 2008

Long established medical interventions to help couples with infertility problems do not seem to improve fertility, according to a study published on today. These findings challenge current practice in the UK and national guidelines should be reviewed in the light of this evidence, say the authors.

One in seven couples in the UK experience infertility. Unexplained infertility affects a quarter of these couples and common interventions to help them have been used for many years in line with fertility guidelines issued by the National Institute for Health and Clinical Excellence (NICE).

A team of researchers led by the University of Aberdeen compared the effectiveness of two specific interventions with expectant management (no treatment).

They recruited 580 women who had experienced unexplained infertility for more than two years from four teaching hospitals and a district general hospital in Scotland. The women were randomised into three groups—one group of women were encouraged to try naturally for a pregnancy and had no medical interventions; one took oral clomifene citrate (CC) which is believed to correct subtle ovulatory dysfunction; and the other 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 who had no interventions had a live birth rate of 17%, the group taking oral CC had a birth rate of 14%, and the group having unstimulated IUI had a birth rate of 23%.

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 (CC and IUI) were reassured by the process of treatment while women who had no interventions were less satisfied, despite it being equally effective.

The researchers conclude: "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 and Yacoub Khalaf from the Assisted Conception Unit at Guy's and St Thomas' NHS Foundation Trust, say: "As a direct result of the lack of evidence, many couples with unexplained infertility endure (and even request) 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 NICE guidelines, which endorse the use of up to six cycles of IUI without ovarian stimulation in couples with unexplained infertility, be reviewed in the light of current evidence.

Source: British Medical Journal

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not rated yet Aug 08, 2008
The reason why we have an "infertility crisis" is very similar to why we have so much genetic variation among human beings.

We've taken ourselves out of the Natural Selection process for the most part. The people who are infertile, excluding those who became infertile due to physical trauma, are most likely the same people who would have died 100 years ago to things like dysentary, cholera, and other common diseases.

By defeating the simple diseases that prey on humans we've allowed those same genetic influences to procreate and be passed down to a point where they have become not viable for reproduction.

Look at the rabbit paradigm. Rabbits, when introduced to a new environment, will procreate until they begin to strain the environment. Then the elder rabbits will go through the pack and kill off the weak or sickly rabbits so that the group does not over-tax their environment to the point of system failure. Then rabbits will begin breeding to replace lost population (lost to predation, disease, etc). If there is a societal malfunction in the group of rabbits then the entire group will die due to failure of their environment. Humans don't do this. We breed and breed and breed and completely ignore dwindling resources until....

We go to war and kill off as many of the people who are trying to utilize our resources as we see fit. There are too many people, and so naturre is flipping the switch for some of us making us unable to reproduce in the rampant fashion that we're accustomed to.
not rated yet Aug 08, 2008
"The people who are infertile, excluding those who became infertile due to physical trauma, are most likely the same people who would have died 100 years ago to things like dysentary, cholera, and other common diseases."

What? I did not know that diseases like the ones you listed preferentially targeted infertile humans over fertile ones.

I'm no expert, but even I can see that the "Infertility Crisis" is due in a large part to women waiting longer to have children due to careers, and modern birth control methods.

Nature is NOT flipping the switch for some of us making us unable to reproduce in the rampant fashion that we're accustomed to, it our modern lifestyle and the birth control pill that is doing that.

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