abdulhakeem
19-10-07, 04:03 PM
October 19, 2007
Mark Henderson, Science Editor, in Washington
Infertile couples may be wasting money and setting back their chances of pregnancy by delaying IVF in favour of hormone-injection treatment, research has indicated.
Unless couples have obvious fertility problems, such as a low sperm count or blocked Fallopian tubes, most clinics put patients through several treatments before trying IVF. Yet one of these treatments, the injection of follicle-stimulating hormone (FSH), achieves nothing more than lengthening the time it takes couples to conceive, according to a study in the US.
The first stage of the traditional treatment plan is usually to give women a drug called clomiphene or Clomid, which promotes ovulation. If this fails, women then progress to FSH injections, which trigger multiple ovulations. This is usually combined with intra-uterine insemination (IUI), in which sperm is injected directly into the womb to ensure that more reach the egg. Only once these procedures have been tried without success does IVF begin.
As more than 70 per cent of fertility treatments in the UK take place in the private sector, FSH injections with IUI typically cost patients between £800 and £1,000. Many doctors dislike the procedure because it raises the chances of twin or triplet pregnancies. The drugs can also cause ovarian hyperstimulation syndrome, which can occasionally cause kidney damage and even death.
The US study, led by Richard Reindollar of the Dartmouth-Hitchcock Medical Centre in New Hampshire, looked at 503 infertile couples in which the women were aged between 21 and 39, half of whom were randomly assigned to different treatment programmes. The first group was given clomiphene with IUI, then FSH injections with IUI, and then IVF. The second received only clomiphene with IUI before moving to IVF.
The overall success rates for both groups were almost identical — 75 per cent of the three-step group became pregnant through one of the methods, compared with 78 per cent of those taking the fast track to IVF.
The fast-track group, however, got results much more quickly. They had a 40 per cent greater chance of getting pregnant within three to eleven months of starting treatment, and their average time to pregnancy was three months shorter. Their treatment was also, on average, $10,000 ($4,900) cheaper.
“What we can say from this is that use of FSH injections with IUI does not offer any added benefit,” Dr Reindollar told the American Society for Reproductive Medicine conference in Washington. “What we have shown is that there is no need for women to add the middle step.”
British fertility experts said that although treatment plans in the UK did not always follow the same model, with different clinics pursuing their own policies, most took a similar approach.
Bill Ledger, professor of obstetrics and gynaecology at the University of Sheffield, said: “It’s reasonably analogous to what we do in the UK. FSH with IUI may become a thing of the past as we become more aware of the risks associated with multiple births. If we try to do IVF cheaply and don’t waste money doing clever things we can get more babies per investment.”
The National Institute for Health and Clinical Excellence recommends that NHS patients be offered six cycles of IUI without drug stimulation before IVF. It recommends IUI with FSH injections only for women with endometriosis.
http://www.timesonline.co.uk/tol/life_and_style/health/article2689681.ece
Mark Henderson, Science Editor, in Washington
Infertile couples may be wasting money and setting back their chances of pregnancy by delaying IVF in favour of hormone-injection treatment, research has indicated.
Unless couples have obvious fertility problems, such as a low sperm count or blocked Fallopian tubes, most clinics put patients through several treatments before trying IVF. Yet one of these treatments, the injection of follicle-stimulating hormone (FSH), achieves nothing more than lengthening the time it takes couples to conceive, according to a study in the US.
The first stage of the traditional treatment plan is usually to give women a drug called clomiphene or Clomid, which promotes ovulation. If this fails, women then progress to FSH injections, which trigger multiple ovulations. This is usually combined with intra-uterine insemination (IUI), in which sperm is injected directly into the womb to ensure that more reach the egg. Only once these procedures have been tried without success does IVF begin.
As more than 70 per cent of fertility treatments in the UK take place in the private sector, FSH injections with IUI typically cost patients between £800 and £1,000. Many doctors dislike the procedure because it raises the chances of twin or triplet pregnancies. The drugs can also cause ovarian hyperstimulation syndrome, which can occasionally cause kidney damage and even death.
The US study, led by Richard Reindollar of the Dartmouth-Hitchcock Medical Centre in New Hampshire, looked at 503 infertile couples in which the women were aged between 21 and 39, half of whom were randomly assigned to different treatment programmes. The first group was given clomiphene with IUI, then FSH injections with IUI, and then IVF. The second received only clomiphene with IUI before moving to IVF.
The overall success rates for both groups were almost identical — 75 per cent of the three-step group became pregnant through one of the methods, compared with 78 per cent of those taking the fast track to IVF.
The fast-track group, however, got results much more quickly. They had a 40 per cent greater chance of getting pregnant within three to eleven months of starting treatment, and their average time to pregnancy was three months shorter. Their treatment was also, on average, $10,000 ($4,900) cheaper.
“What we can say from this is that use of FSH injections with IUI does not offer any added benefit,” Dr Reindollar told the American Society for Reproductive Medicine conference in Washington. “What we have shown is that there is no need for women to add the middle step.”
British fertility experts said that although treatment plans in the UK did not always follow the same model, with different clinics pursuing their own policies, most took a similar approach.
Bill Ledger, professor of obstetrics and gynaecology at the University of Sheffield, said: “It’s reasonably analogous to what we do in the UK. FSH with IUI may become a thing of the past as we become more aware of the risks associated with multiple births. If we try to do IVF cheaply and don’t waste money doing clever things we can get more babies per investment.”
The National Institute for Health and Clinical Excellence recommends that NHS patients be offered six cycles of IUI without drug stimulation before IVF. It recommends IUI with FSH injections only for women with endometriosis.
http://www.timesonline.co.uk/tol/life_and_style/health/article2689681.ece