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For some, 2 fertility drugs don’t perform




LONDON

A new study calls into question the use of two common infertility treatments for couples who have unexplained problems having children.

Doctors in Scotland tested the effectiveness of a drug that stimulates ovulation and artificial insemination against doing nothing in 580 couples who had no obvious reasons for their inability to conceive.

Among the three groups, researchers found little difference in the numbers of couples who had babies. The study was published in the British Medical Journal.

“These treatments are a leap of faith,” said Dr. Siladitya Bhattacharya, a professor of reproductive medicine at the University of Aberdeen and the study’s lead author. “None of the treatments studied had any significant benefit over no treatment at all.”

Doctors usually try fertility pills or artificial insemination before moving on to more complicated and expensive techniques like in-vitro fertilization.

Bhattacharya and colleagues studied 580 couples who had no obvious reasons for their inability to conceive. Infertility affects about one in seven couples.

Couples were followed for six months between 2001 and 2005. Of those, 193 couples were given “expectant management,” or simply counseled on the need to have regular sex.

Clomifene citrate was given to 194 women. In the last group, doctors performed an artificial insemination in 193 women, a process where sperm are injected into the womb using a syringe.

In Britain, clomifene citrate costs the equivalent of about $390 per course and artificial insemination costs about $975 per cycle.

Clomifene citrate has side effects including nausea, headaches, and hot flashes. It also increases the chance of having twins.

Women who were pregnant after six months were then monitored until they gave birth.

Among the couples who were not treated, 32 had babies. That compares to 26 babies for the women who took fertility pills and 43 for those who had artificial insemination. Experts said the slight differences were not statistically significant.

“It’s not in the realm that you would expect it to be if these interventions were really performing,” said Allan Pacey, of the University of Sheffield and secretary of the British Fertility Society. He was not linked to the study.

Still, Pacey said that artificial insemination was still useful for certain couples, such as if donor was were being used, if the man was in a wheelchair, or if the woman had a problem with her cervix.

Fertility drugs like clomifene have long been shown to work in women who have difficulties ovulating.

The study, paid for by the Scottish government, should spark a revision of medical guidelines, which could save governments and couples a lot of money and unnecessary risk, said Dr. Tarek El-Toukhy, a fertility doctor at Guy’s and St. Thomas’ Hospital in London. El-Toukhy co-authored an accompanying editorial in the British Medical Journal.


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