For some couples having trouble conceiving, no treatment at all is as effective as the most widely used first-line infertility therapy, new research suggests.
About 10 percent of couples fail to conceive after a year of trying; for as many as one-third, no obvious cause can be found.
Intrauterine insemination (IUI), in which sperm is collected and medically inserted into the uterus, combined with infertility drugs which stimulate multiple egg production, is the most commonly recommended early treatment for such couples.
Because the treatment is costly and carries the risk of multiple births, researchers in the Netherlands hoped to identify women with unexplained infertility who may not need it.
When they compared outcomes six months after treatment with IUI plus ovarian stimulation to no treatment in a group of these women, they found the untreated women were slightly more likely to achieve an ongoing pregnancy.
“Our study shows that identification of couples who will not benefit from intrauterine insemination is possible,” researcher Pieternel Steures of the Center for Reproductive Medicine in Amsterdam wrote in the July 15 issue of the journal The Lancet.
Outcomes the Same
The researchers used an established prediction model to identify couples with what they described as an intermediate chance of achieving a pregnancy without treatment within a year.
By assessing characteristics such as the woman’s age, infertility duration, whether she had been pregnant before, and other variables, the researchers identified 509 out of 3,221 couples -- slightly less than one in six of those evaluated -- who had a 30 percent to 40 percent chance of achieving a spontaneous ongoing pregnancy within the next year.
Researchers recruited 253 of these couples to either receive treatment, or to get no treatment, for the next six months.
Treated vs. Untreated
Of the 127 couples who got IUI plus drug treatment, 29 (23 percent) achieved ongoing pregnancies, compared to 34 (27 percent) of the 126 untreated couples.
One twin pregnancy occurred in each group; one woman who received treatment conceived triplets.
Steures and colleagues conclude that for selected couples, delaying treatment -- known medically as expectant management -- is a better option than active treatment, which increases the risk for multiple births.
“The treatment for patients with very good and very bad prognoses is clear, but it is not so clear for those who are in between,” Steures tells WebMD. “Delaying treatment for six months makes sense for this group of patients.”
Some Women Shouldn’t Wait
That may be true, infertility specialist Steven J. Ory, MD, tells WebMD, provided the woman has time to wait.
He points out that the women in the study were relatively young -- with an average age of 33 -- compared to most in the U.S. who seek treatment for infertility.
“Delaying therapy in women under 35 may not be particularly dangerous,” he tells WebMD. “But you don’t want to delay too long after this age.”
Ory, who is president elect of the American Society for Reproductive Medicine, says reducing multiple births is a big concern, and one the reproductive medicine community is addressing.
“Concerns about multiple pregnancy are very valid, and it is true that a certain amount of indiscriminant use of these therapies in the past has contributed to the problem,” he says. “But the other side of this is that we cannot deny treatment to couples who are fully cognizant of this risk.”
By Salynn Boyles, reviewed by Louise Chang, MD
SOURCES: Steures, P. The Lancet, July 15, 2006; vol 368: pp 216-221. Pieternel Steures, Academic Medical Center, Center for Reproductive Medicine, Amsterdam, Netherlands. Steven J. Ory, MD, president elect, American Society for Reproductive Medicine; private practice, Margate, Fla.