The treatment of unexplained infertility: still needed answers

Unexplained infertility is frustrating for couples and their doctors. No specific reason why a woman has trouble getting pregnant, it is difficult to choose a treatment that has a high success rate but not increase the chances of multiple high-risk pregnancy. A study published today in the New England Journal of Medicine compared three drugs commonly used to treat unexplained infertility. Unfortunately, there was no clear winner.

Infertility is defined as the inability to become pregnant after one year of appropriate efforts at the right time. Infertility affects about 10% of women between 15 and 44. For those who want a child, the inability to become pregnant can be devastating, and the desire to seek treatment is understandable. 

The first usual step along this path is a detailed assessment of the couple. Almost half of the time, when a problem is identified, the male partner is generally a problem with his sperm. Sometimes we discover that a woman has blocked fallopian tubes (egg can not be fertilized and travels to the uterus) or uterine cavity abnormalities such as fibroids (which can prevent a fertilized egg from implanting) .

But in 15-20% of cases, no reason was identified - the so-called "unexplained infertility."Many unexplained infertility become pregnant on their own, just with more time. But for those who do not want to wait, the first step is to try to use drugs to push the ovaries to mature more than one egg (called ovulation induction).  

With more eggs available for fertilization cycle, the hope is that at least one result in a pregnancy. This therapy is simpler and much less expensive than in vitro fertilization (IVF). Cost is a significant problem because the finance can be a major barrier to treatment of infertility. Few states require insurance plans provide coverage for IVF, which can easily run more than $ 10,000 per cycle, or "treat".

But every time you drive the ovaries to produce more eggs, you run the risk of "super-ovulation," or do a lot of eggs available for fertilization. This means that the risk of "multiple pregnancy" run -.. Twins, triplets and beyond for couples desperate to build a family, most babies can seem to hit the jackpot But multiple pregnancies are the biggest risk of infertility treatments, and probably should be counted as failures rather than successes These pregnancies. - even with twins "only" - mean babies are more likely to be born prematurely and mothers are more likely to suffer complications. Both situations can be serious and have long-term consequences.

So what medications they are best placed to achieve the infertility treatment goals - IE achieving a pregnancy with a baby? In this study, a national network of researchers examined how the drug letrozole compared to two standard drugs to stimulate ovulation. Letrozole works to stimulate ovulation by a different path than traditional fertility drugs.

The researchers assigned cver thousand couples suffering from unexplained infertility to a maximum of four per letrozole treatment cycles or one of two "standard treatments" gonadotropins (Menopur is a brand name) or clomiphene (Clomid is a brand name common). Results: live birth rates were lower in women taking letrozole (19%) compared with the gonadotrophin (32%), but were statistically similar to clomifene (23%). 

Furthermore, multiple pregnancy rates (twins and triplets while in this study) were higher in the group of gonadotropin (all triplets were in the treatment group) than in the letrozole groups and clomiphene (which was about the same rate).

Just a home run for those waiting letrozole would be the answer. In general the figures suggest that for couples suffering from unexplained infertility, these alternatives to IVF can help achieve pregnancy - but success is not a sure thing. Drugs that offer a greater chance of pregnancy, also provide a greater chance that the pregnancy is high risk.

Although disappointing, the results call for more work to optimize fertility treatments. An important part of this work - and we talk about ovulation induction or in vitro fertilization - continue efforts to reduce the high rate of multiple pregnancies that carry unsatisfactory current treatment options. Until we have answers, the sound therapy the means of properly limiting Dosage ovulation induction, and in the case of IVF, which limits the number of embryos transferred. This means doctors need to help patients make wise decisions, especially when more than one embryo available for transfer.

The true and sincere objective of couples and their physicians is not only pregnancy, but pregnancy with good results, a healthy mother and a healthy baby. Here, more is not better results.
By: Jeffrey Ecker, MD.