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A raw study promulgated on bmj.com
has found that fertility is not improved in sterile couples wHO have
been treated with long-established medical interventions. The team of
researchers lED by the University of Aberdeen has called for UK and
national guidelines to be reviewed with this new evidence that
challenges current practices.
In the UK, one in seven couples experience infertility. Of these, about
25% of the infertility is unexplained, and the criterion treatment
includes a body of common interventions that have been used for years
and have been issued by the National Institute for Health and Clinical
Excellence (NICE).
The research squad set out to compare two specific interventions with
expectant management (i.e., no intervention). From quatern teaching hospitals
and a district general hospital in Scotland, they recruited a sample of
580 women who own had unexplained infertility for over deuce years. The
women were arbitrarily assigned such that one group had no medical
intervention and tried naturally to become pregnant, a second radical
took oral clomifene citrate (CC) to correct subtle ovulatory
disfunction, and a third group received unstimulated intra-uterine
insemination (IUI) of sperm.
During the course of the study, 101 women became pregnant and had a
alive birth. The birth pace for women with no intervention was 17%, and
the rates for the oral CC group and the IUI group were 14% and 23%,
respectively. According to the researchers, the 6% difference between
the IUI and the non-intervention group is no large enough for the
results to suggest a meaningful and significant advance in the live
parentage rate.
Many women suffered from side effects that included: pain, bloating,
hot flushes, nausea and headaches. These affected approximately 10 to 20% of
women, most of whom were taking oral CC. Also, it is worth noting that
satisfaction was higher in the groups of women being actively treated -
as they were reassured by the treatment process - compared to women who
received no intervention.
"These interventions, which have been in use for many years, ar
unlikely to be more effective than no treatment. These results
challenge stream practice, as endorsed by a national guideline in the
UK," conclude the authors.
Tarek El-Toukhy and Yacoub Khalaf (Assisted Conception Unit at Guy's
and St Thomas' NHS Foundation Trust) write in an incidental editorial
that: "As a direct resolution of the lack of evidence, many couples with
unexplained infertility endure (and even request) expensive,
potentially hazardous, and often unnecessary treatments." There is a
need for high quality clinical trials as well as better information for
patients to determine the best treatments in light of strength and
adverse effects. El-Toukhy and Khalaf also call for the current NICE
guidelines to be reviewed with this inquiry in mind.
Clomifene citrate or unstimulated intrauterine insemination
compared with anticipative management for unexplained sterility:
pragmatic randomized controlled trial
S Bhattacharya, K Harrild, J Mollison, S Wordsworth, C Tay, A Harrold,
D McQueen, H Lyall, L Johnston, J Burrage, S
Grossett, H Walton, J Lynch, A
Johnstone, S Kini, A Raja, A Templeton
BMJ (2008). 337: a716.
doi:10.1136/bmj.a716
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Written by: Peter M Crosta
Copyright: Medical News Today
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