Doctors in Scotland tested ovulation stimulating drug and artificial insemination against completely untreated couples who had no clear reasons of infertility.

Researchers found minute difference in the number of couples who had babies, among the three groups. The study was published Friday in the British Medical Journal.

”These treatments are a leap of faith,” said Dr. Siladitya Bhattacharya, the study’s lead author. ”None of the treatments studied had shown any significant benefit over without treatment at all.”

Infertility affects one out of seven couples. Doctors frequently try fertility pills or artificial insemination prior to moving on to more complex and expensive methods such as in-vitro fertilization. Bhattacharya said that “he and the five study centers no longer recommend the two tested treatments for unexplained infertility problems.”

First group consisted of the 580 couples in the study were simply advised to have regular sex. Second group got clomifene citrate, which stimulates the process of ovulation. For the third group, artificial insemination is performed, injecting sperm into the uterus with the help of syringe.
Women who were pregnant after six months were then monitored till the time of delivery.

In the untreated group who were only recommended regular sex, 32 couples had babies. That compares to 26 babies for the women who took fertility pills and 43 for those who had artificial insemination. Experts said the differences are statistically negligible.

”It’s not in the realm that you would expect it to be if these interventions were really performing,” said Allan Pacey, of the University of Sheffield and secretary of the British Fertility Society.

Still, Pacey said that “artificial insemination was still useful in certain conditions, such as when donor sperm is used.”

Fertility pills like clomifene have long been shown to stimulate ovulation with side effects include nausea, headaches, and hot flashes. These fertility drugs also increases the chance of having twins.

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Women of developing countries are delaying childbirth till the age of infertility is about to strike. Consequently, most of them are adopting the assisted reproductive technologies to conceive. High risk of adverse health outcomes in infants has been associated with the assisted fertilization, but it is hard to differentiate between the effects of the procedure itself from the effects, that might be inherent in the birthing couple.

To differentiate between these two effects, reasearchers performed a population-based group study, selecting women older than 20 who had one singleton pregnancy and one after AF. Then infants were examined for birth weight, gestational age, premature birth, and perinatal deaths from 2,546 Norwegian women over 20. These results were compared with rates in 1,200,922 single birth controls and 8,229 AF controls.

It showed that AF conception was related to:

• lower average birth wight by 25 g
• shorter gestation period by 2.0 days
• 26 percent elevated risk of being undersized for gestational age
• 31% percent risk of perinatal death.

Women in whom, factors, other than AF were controlled i.e. the women who had conceived both spontaneously and by AF, the AF babies had:

• a lower average birth weight by 9 g
• a shorter gestation period by 0.6 days
• a similar risk of being undersized for gestational age
• a 200 percent increased risk of perinatal death.

The researchers conclude that “Birthweight, gestational age, preterm delivery and risks for short gestational age, did not differ among infants of women who had conceived in both ways. The adverse outcomes of assisted fertilization that we noted compared with those in the general population could therefore be attributable to the factors leading to infertility, rather than to factors related to the reproductive technology.”

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