Fertility guidelines review needed

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A study into the drug clomifene citrate and artificial insemination found that couples using either method did not have significantly higher chances of falling pregnant than those not having treatment.

Experts writing in the British Medical Journal (BMJ) said current guidelines needed to be reviewed in light of the findings.

One in seven couples in the UK experience infertility, with around a quarter of these having unexplained fertility. Interventions to help these couples have been used for many years in line with fertility guidelines issued by the National Institute for Health and Clinical Excellence (Nice).

Unexplained fertility relates to couples who have had investigations which have failed to find abnormalities. These investigations may include semen analysis, checks on fallopian tubes and assessment of ovulation.

For the study, 580 women from four teaching hospitals and one general hospital in Scotland were divided into groups. All the groups were comparable in terms of age, body weight and the men's sperm quality.

One group of 193 women were given advice on having sex regularly but left to try to conceive naturally. Another 194 women were given clomifene citrate, which is inexpensive and is believed to correct subtle ovulatory dysfunction.

The remaining 193 were given unstimulated intrauterine insemination (IUI), which is thought to enhance the chance of pregnancy by overcoming the cervical barrier. All treatments were followed for six months.

At the very end of the study, there had been a total of 101 live births. There were 32 births among the 193 women trying to conceive naturally (17%), compared with 26 among those on the drug (14%) and 43 among those having insemination (23%).

Although those receiving insemination had a higher rate of pregnancy, the experts said this was not significant enough to be solely down to the procedure. To have a meaningful and significant improvement in the live birth rate, the difference would have to be much higher than the 6% reported in the trial.