# Fertility treatments 'no benefit'



## Shellebell (Dec 31, 2004)

This is off the BBC News website, it DOES say for 'unexplained' but they are not making that clear in the actual TV reports  It's regarding Clomid and unstimmed IUI not being any better than other unexplained couples leaving it to nature 

Fertility treatments 'no benefit'

One in seven couples have fertility problems 
Two common treatments for fertility problems do not work, an Aberdeen University-led study suggests.

UK guidelines recommend the drug clomid and artificial insemination for couples who have trouble conceiving, despite no known cause for the their infertility.

But trials of 580 women in Scotland found the treatments were no better than trying to get pregnant naturally, the British Medical Journal reports.

A third of couples who struggle to get pregnant have unexplained infertility.

It means, despite a battery of tests, doctors cannot find a reason why they struggle to conceive.

It sends a positive message that the chances of success spontaneously are pretty convincing

Professor Siladitya Bhattacharya, study leader

The options listed by the National Institute of Clinical and Health Excellence (NICE) include up to six cycles of unstimulated intrauterine insemination - where sperm is inserted directly into the woman's womb - and use of clomid (clomifene citrate), a drug which stimulates the ovaries.

The treatments have both been offered for many years because "doing nothing" is an unpopular choice among patients, the researchers said.

But until now there has been little rigorous testing of their effectiveness.

Success rate

Five hospitals were involved in the study: Aberdeen Royal Infirmary, Edinburgh Royal Infirmary, Ninewells Hospital in Dundee, Falkirk and District Royal Infirmary and Glasgow Royal Infirmary.

Scientists from Oxford University also took part in the research.

In the six-month study, participants had all suffered unexplained fertility problems for more than two years.

Overall, 101 women ended up having a successful pregnancy.

Of those who tried to conceive naturally, 17% became pregnant and gave birth to a live baby.

For clomid, the birth rate was 14%, and insemination 23% - not significantly different from the chances of success with no intervention.

However, the women undergoing active treatment were more reassured.

Between 10 and 20% of women taking the drug had side-effects, including abdominal pain, bloating, hot flushes, nausea and headaches.

The drug also increases the risk of twins and triplets, which can be more dangerous for mother and babies than a singleton pregnancy.

But the researchers were quick to point out that it is a very useful treatment for women who have problems with ovulation.

'Cheap but common'

Study leader, Professor Siladitya Bhattacharya, from the University of Aberdeen, said the findings challenge current practice.

"The first thing is it sends a positive message that the chances of success spontaneously are pretty convincing."

He added: "These treatments are cheap but common - if you total all the money, time and effort spent on them, it's considerable."

In an accompanying article, researchers from the Assisted Conception Unit at Guy's and St Thomas' NHS Foundation Trust, said because of the lack of evidence, many couples with unexplained infertility endure "expensive, potentially hazardous, and often unnecessary treatments".

Dr Allan Pacey, senior lecturer at the University of Sheffield and secretary of the British Fertility Society, said: "It is very important that we have a strong evidence base to support the treatments that are offered to infertile couples and as such this study is very valuable.

"Intrauterine insemination has been offered to couples with unexplained infertility for many years, but if there is no benefit in doing so then we should re-evaluate the clinical guidelines so that NHS money is used wisely."


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## ♥Saila♥ (Mar 27, 2006)

This is in the Sun also

http://www.thesun.co.uk/sol/homepage/woman/health/health/article1530294.ece


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## Viking Girl (Aug 20, 2006)

Just been on BBC Breakfast - at least they did stress that this was related to "unexplained" infertility


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## Anthony Reid (Jan 1, 2002)

The study...

http://www.bmj.com/cgi/content/full/337/aug07_2/a716

It will also be on ITN/ITV tonight


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## caz24 (Nov 25, 2004)

i read this on teletext, and it didn't even say anything at all about it being related to unexplained! it actaully really   me off! lol

ive read it again properly online since x

take care x


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## professor waffle (Apr 23, 2005)

I also saw the BBC report which did state it was only results for unexplained infertility. They applied the same view to IUI as clomid & whilst I agree with them on clomid (it eitherworks or makes things worse for some - I don't have PCOS but ended up with cysts on 2 cycles) I don't agree with what they say about IUI. I'd been ttc for 5 years before getting pg with DS, I am unexplained & I truly don't think it would have happened naturally for me at my age

I also think a lot of women are labelled as unexplained at the early stages because they don't investigate things like hostile cm, sperm antibodies etc. I think I had a hostile CM problem which is why IUI worked for me but it's not investigated, neither is luteal phase defect which again is dismissed but I have read other ladies on here saying they think it does exist. For me a LPD was also a problme but wasn't investigated or taken seriously although at my request I was given cyclogest on the last 3 cycles.

I hope this now means that clomid won't just be dished out to all & sundry ahving problems ttc, the side effects are horrible but the drug is cheap & CAN work but only for a minority of ladies.


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## Katy H (Aug 22, 2006)

Like so many things these days a sensible, carefully-written piece of research gets dumbed down in the media and becomes misleading.  I listened to the author of the Aberdeen study and Professor Lord Winston discussing the research on the Today Programme on Radio 4; it was a measured and thought-provoking debate.  

One of the most interesting points (made by Prof Winston) was that because so much fertility treatment in the UK is private rather than NHS, there is actually very little research going on.  He even suggested there was a risk of infertility treatment becoming less successful in the future because of the lack of research.  That must surely be a REAL worry to all of us!

Katy x


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## cherriepie (Nov 3, 2007)

Hey All

I saw this news story on Channel 4 News at Noon and I agree - it's been reported in the most inept manner which, unfortunately is often true when the media report on this topic.

The jist of the story, as portrayed by Channel 4, is that people with unexplained infertility should just be left and not offered treatment and I think this is just ludicrous - why aren't they saying that more tests should be offered in the early stages to try and pinpoint why it's not happening?  My infertility has been diagnosed and today I am truly thankful for that.  I think this would have come as such a blow to those with unexplained infertility and my heart really goes out to them.

The report said that the study was carried out on 580 women.  They were split into three groups:-

1.  Received Clomid
2.  Artificial Insemination (otherwise known as IUI - they couldn't even use the correct term here)
3.  Received no treatment.

The results were:-

1.  Clomid - 14% of treatment resulted in the birth of a tiny miracle - that's 27 couples receiving the gift that they have so longed for!
2.  IUI - 23% of treatment resulted in the birth of a tiny miracle - that's 44 couples receiving the gift that they so longed for!
3.  17% of those receiving no treatment had a baby.

Suffice to say that if they had even bothered to ask the people in the study if it was worth it there would be a RESOUNDING  "Hell Yes!".

NHS funding is hard enough to come by for most health boards and reports like these will only make it harder. 

I just wish that the media would look into infertility a little deeper and report on it more sensitively as they would with other things, research these studies more and report more accurately!


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## Topkat08 (Jul 23, 2008)

I hope &   that im in that 14%
With just finishing my 4th cycle of clomid i was feeling positive  but reading this has just made me feel down.   I feel like we're being fobbed off.   
i read something about the SE of clomid & yes it is horrible having hot flushes, mood swings etc but i just put is down as nothing ventured nothing gained & if it brings us a little healthy miracle surely all the SE are well worth it. 
The clomid has made me ovulate so theres abit more hope i suppose.

Take Care Ladies
Nikki x x


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## cherriepie (Nov 3, 2007)

Hey Topkat

Just wanted to say good luck!!!  

Will keep you in my prayers   and keep my fingers firmly crossed for you.

xxxxxxxxxxxx


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## Topkat08 (Jul 23, 2008)

thanks Cherrypie hun xx


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## professor waffle (Apr 23, 2005)

Topkat if it  makes you ovulate then clomid helps but it is given to ladies who ovulate anyway as well(I had it) but there are other drugs which do the same thing with less side effects (tamoxifen & letrazole). For PCOS ladies clomid can make cysts worse & cause problems with womb lining.

For those who clomid works for it's a fab drug, but there are others out there which are generally not used because they are more expensive.


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## Caz (Jul 21, 2002)

I wish the majority of news reports had made it more obvious what the treatments were and what body of IF patients they affected. 



professor waffle said:


> I hope this now means that clomid won't just be dished out to all & sundry ahving problems ttc, the side effects are horrible but the drug is cheap & CAN work but only for a minority of ladies.


Funnily enough, I was given 8 months of clomid after only having one blood test (day 21) that seemed to indicate I wasn't ovulating. Completely ignorant of how things work I duly did the test on day 21 as instructed, despite the fact I had a 30-32 day cycle at the time and likely didn't ovulate until day 18 - well yes it would show I didn't ovulate then wouldn't it! I have later, through FF, found that I probably should have had it on day 24 or 25 to give an accurate result and subsequent natural FET cycles seem to suggest that, in fact, I do ovulate quite happily on my own ta.
It was only after I wasted 8 months - a year by the time appointments came through - that I was sent for other tests and found out I have PCO and a blocked tube and, combined with my DH's less than fantastic SA, my best hope at conception was IVF. Given that my cons had treated me for endo only 2 years before then you'd think he'd have checked for obstructions first! I guess all in all it cost me nearly 15 months in fertility terms and I still do feel really annoyed when I think of the time I wasted as it could have made the difference between me being young enough to egg share again for a sibling and, not as I am now. 
I get so frustrated when I see new members who are getting the brush off by doctors or offered treatments that don't seem appropriate to their diagnosis or before full investigations are carried out. We're vulnerable enough without beign experiemented on.

C~x


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## professor waffle (Apr 23, 2005)

Caz I was given 6 months of clomid with no monitoring at all & just sent away as if the job was done for now. I do feel that clomid has been the first course of action to get people off the waiting lists & show that they are 'being dealt with'. I have a friend who suffers really really badly with clomid but has been refused tamoxifen - I can't see any reason for this other than the cost. Clomid is about £10  a pack whereas tamoxifen/letrazole is £5 per tablet!


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## Rachel2 (Oct 3, 2004)

I was concerned how this report was put across on The Wright Stuff yesterday. Anne Diamond actually made it sound as though the report was talking about people with a known problem, and the unexplained part wasn't even mentioned. I was unexplained and after a long time trying we conceived dd first go of iui - so I'm sure that wasn't coincidence!! We are still trying for no 2 but if I'd still been trying for no 1 and read this I would have felt so angry that I might be refused treatment eventually. Even psychologically there is a benefit as you don't feel so hopeless when something is being done. Grr!


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## samper (Aug 16, 2006)

I think the problem with this article is that it bundles IUI and clomid up. TBH I am appalled by just how easily clomid is dished out to people.

Like Caz I was given it for 9 months after only the most rudimentary of tests; I had awful side effects and my cons discharged me with no monitoring and the gp refused to review it with me because he hadn't prescribed it.

As far as I was concerned thise 9 months were a total waste of time, and I could have used them better seeking private treatment earlier.

I really hope that it makes cons think a bit more before just doling it out to anyone.


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## cherriepie (Nov 3, 2007)

Know what you mean Samper.  A friend of mine had a hellish 3 years on clomid!!!!

She has eventually changed GP and changed consultant and is now waiting for first cycle of IVF to begin this month - she just feels that the whole three years was for nothing, a complete waste for her and just the most awful experience.

Am hoping and praying that all goes well for her and everyone!

xxxxx


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## Caz (Jul 21, 2002)

professor waffle said:


> Caz I was given 6 months of clomid with no monitoring at all & just sent away as if the job was done for now. I do feel that clomid has been the first course of action to get people off the waiting lists & show that they are 'being dealt with'. I have a friend who suffers really really badly with clomid but has been refused tamoxifen - I can't see any reason for this other than the cost. Clomid is about £10 a pack whereas tamoxifen/letrazole is £5 per tablet!


Yes I absolutely agree and it's the fact it is so cheap that makes me suspect that all the more.
The thing is though, if you give clomid to someone who ovulates on their own and without monitoring, surely you increase the risk of them producing multiple follicles and, potentially, a multiple pregnancy.  With all the debate about introducing SET for IVF patients specifically to cut the risk of multiples....smacks of double standards a bit!



Rachel2 said:


> Even psychologically there is a benefit as you don't feel so hopeless when something is being done. Grr!


I see your point but, to be fair, I don't think there's any benefit to offering a treatment just for the patient to feel like there's something being done and especially not when there is no better chance of it succeeding over natural conception - although obviously in your case it did bring a very happy outcome so there's every reason to think it might do so again.  At the very least the patients should be made aware of their chances of success with clomid / IUI and the risks involved. 
I actually think the big issue is that Unexplained is such a widly used diagnosis - if your tubes are clear, ovaries and uterus look ok, bloods tests come back normal and there are no obvious male factors then it seems the Unexplained diagnosis is stamped on your chart and you're sent off down the pre determined course of x months clomid, x number of IUIs and then, oh dear, if that doesn't work you have IVF to contend with...when you've already been through so many months and so much disapointment already. You know, as much as I get angry with my own body for being so naff, I feel sort of relieved that at least I have a label for my IF and I can direct my anger towards that. It must be so dreadfully frustrating to not know why and then disheartening to go through all that. 
They should start looking a bit deeper into why there is no conception taking place. I.e. is it hostile mucus? Yes, then IUI "solves" that. Is there thyroid problems? Immune issues? Yes, then correct them. Even just basic stuff like lifestyle and BMS habits. In all my consultations and investigations I was never once asked how frequently me and my DH did the deed!  That's not to say every case of unexplained will be explained but I can't help wondering how many more would be (and then be more appropriately treated) if they covers *all* the bases.

C~x


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## Rachel2 (Oct 3, 2004)

I know - I asked for my mucus to be tested but was told that as it changes daily it is very hard to come to any conclusion. I would love to know whether my mucus is hostile or not, as dh's sperm has improved dramatically and if I knew cm was OK I'd have more hope of a natural conception. As it is we will be having ivf in November. x


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## Wraakgodin (Jun 17, 2006)

That is one thing that I wondered about Rachel, I didn't know there was a test for mucus. We have "unexplained" infertility - more like they haven't looked hard enough!

I did ask the hospital if there were any more tests they could do, but they said if they kept doing tests and investigations then we would never get round to having treatment! They said that they have covered all the main causes, and if the 3rd or 4th IUI fails then they will do more tests!

Good luck with the IVF in November!

Sue


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## Rachel2 (Oct 3, 2004)

Thanks Sue - there is definitely a test for cm but our cons said it was very difficult to get an accurate result - but then he will be getting a huge cheque from us in November which does make you wonder...! x


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## Greeneyed (Apr 12, 2006)

Hi ladies my concern about this article is that it may make the casual uninformed reader assume that IF treatments don't work wholesale and that the NHS should not be spending money on them. It also gives the impression that if you are unex it will happen for you anyway 

Quote "The first thing is it sends a positive message that the chances of success spontaneously are pretty convincing." 

17% is not hugely positive in my eyes! What about the other 83% who don't get pregnant. 

It is another way of trivialising the problem, fueling the just relax and it will happen myth.


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