Comparing two treatment protocols for couples with unexplained infertility

This trial compares two treatment protocols for couples without a known cause for infertility: a conventional and an accelerated regimen. 

Fertility treatments and procedures are usually given in a step-wise fashion. For most couples with trouble conceiving, the first fertility treatment given is clomifene citrate, followed by intrauterine insemination. Clomifene citrate is a drug used to stimulate ovulation (release of eggs by the ovaries).Intrauterine insemination (IUI) is a procedure to introduce sperm directly into the uterus. If the clomifene citrate/IUI protocol fails, the next step is ovarian stimulation with FSH  – follicle stimulating hormone, followed by IUI. FSH is a hormone produced by the body to induce ovulation. If these treatments fail, couples are usually referred to IVF (in-vitro fertilization). IVF is an advanced procedure in which eggs are collected from the woman and fertilized in a laboratory dish using sperm from the male partner. After fertilization, the resulting embryo is inserted into the uterus. Several embryos are typically inserted at the same time to ensure one of them successfully develops into a baby.

The present study compared two fertility treatment strategies: conventional and accelerated. The conventional strategy involved initiating fertility treatment using clomifene citrate plus IUI, followed by FSH plus IUI and then IVF. The accelerated strategy involved starting fertility treatment using clomifene citrate plus IUI and directly moving to IVF in case of failure. The study initially enrolled 503 couples, of which 417 followed the entire treatment protocol. Results showed that 64% of all couples enrolled succeeded in conceiving a baby. At 12 months after starting treatment, 55.4% of couples receiving conventional treatment had conceived, compared to 65.4% in the accelerated group. The median time it took to establish a pregnancy was 11 and 8 months, respectively. The number of multiple pregnancies was similar with either treatment. When considering financial cost, the conventional treatment seemed to be more expensive than the accelerated treatment.

This study found that the accelerated fertility protocol was more successful and less costly than the conventional approach. FSH/IUI treatment was of no added value.

This paper did not discuss the influence of age on treatment success. Younger women may have higher chances of conceiving with IUI and may be able to postpone IVF.

If you suffer from unexplained infertility, discuss with your doctor all treatment options, and the recommended treatment protocol(s) in your case.