Questions raised over IUI fertility technique
Dr Jess Buxton
Progress Educational Trust17 July 2006
A technique commonly used to treat couples with unexplained fertility problems is ineffective for many of them, say Dutch researchers. A team based at the Academic Medical Centre and Vrije Universiteit Medical Centre in Amsterdam has shown that 30 per cent of those treated with intrauterine insemination (IUI) would be better off continuing trying to conceive naturally. The scientists, who published their findings in the Lancet medical journal, say that for couples with a more than 30 per cent chance of pregnancy, using IUI combined with ovarian hyperstimulation offers no benefit.
Couples who have not conceived naturally after one year of trying are often offered IUI as a first treatment. During this procedure, the man's sperm is placed directly into the woman's womb while she is ovulating. In addition, the woman is often given a hormone drug to stimulate her ovaries (ovarian hyperstimulation) and increase the chances of pregnancy. However, the treatment is costly, and also increases the chances of a multiple birth. In the latest study, team leader Mrs Pieternel Steures wanted to see if IUI with ovarian hyperstimulation is any more effective than simply advising the couple to continue trying to conceive naturally.
The researchers studied 253 couples who were having problems becoming pregnant, but who were judged to have a 30-40 per cent chance of eventually conceiving without fertility treatment. The participants were randomly assigned into one of two groups: one of which received the IUI treatment, while the other couples just received healthy lifestyle advice to increase their chances of success. After six months, 42 of the treated women had conceived, and there were 29 ongoing pregnancies, while in the untreated group 40 women had conceived, resulting in 34 ongoing pregnancies. The authors conclude that the technique is 'highly unlikely' to be beneficial for couples who have more than a 30 per cent chance of natural conception. 'Through selection of these couples, the misuse of facilities and other resources can be avoided', said Mrs Steures.
Commenting on the study, Dr Richard Kennedy of the British Fertility Society (BFS) told the BBC News website that 'it provides some reassurance to couples that the "do nothing" option can produce results', adding 'we should be giving this advice to patients'. However, he also said that for couples who are desperate to have a baby, being told by a fertility specialist to go away and do nothing for six months would be 'quite a hard pill to swallow'. He advised that decisions should be reached jointly between a couple and their doctors, and also cautioned that each case would be different. The UK's National Institute for Health and Clinical Excellence (NICE) recommends that IUI treatment should be offered after three years of unexplained infertility.
Reproduced with permission from BioNews, an email and online sources of news, information and comment on assisted reproduction and genetics.