Medische behandelingen, voor vrouwen die zwanger willen worden niet beter dan afwachten*
Uit een Schotse studie blijkt dat behandeling met medicijnen zoals clomid en kunstmatige
inseminatie bij vrouwen, die om onverklaarbare wijze onvruchtbaar lijken te zijn, geen betere resultaten geeft dan gewoon afwachten. Medicijnen geven behalve bijwerkingen misschien wel een wat lagere kans op het krijgen va een baby.
Use of clomiphene citrate (clomifene citrate) or unstimulated intrauterine insemination is no more effective than expectant management in increasing fertility in couples, according to the results of a randomized controlled trial reported in the August 8 Online First issue of the BMJ.
"Unexplained infertility affects a quarter of infertile couples, some of whom have a reasonable chance of spontaneous live birth," write S. Bhattacharya, from the University of Aberdeen, United Kingdom, and colleagues. "Expectant management, however, is not a popular option, and several empirical interventions have been used for many years without rigorous prior evaluation. Commonly used first line treatments for unexplained infertility include clomifene citrate and intrauterine insemination."
The goal of this 3-group, parallel-group, pragmatic, randomized controlled trial was to compare the effectiveness of clomiphene citrate and unstimulated intrauterine insemination with expectant management for the treatment of unexplained infertility.
At 4 teaching hospitals and a district general hospital in Scotland, couples with infertility for more than 2 years, confirmed ovulation, patent fallopian tubes, and motile sperm were randomly assigned to receive expectant management, oral clomiphene citrate, or unstimulated intrauterine insemination. The main endpoint was live birth; secondary endpoints were clinical pregnancy, multiple pregnancy, miscarriage, and acceptability of treatment.
Of 580 women enrolled in this study, 193 were randomly assigned to receive expectant management, 194 to oral clomiphene citrate, and 193 to unstimulated intrauterine insemination for 6 months. Age, body mass index, duration of infertility, sperm concentration, and motility were comparable in these 3 groups.
Live birth rates were 32 (17%) of 193 with expectant management, 26 (14%) of 192 with oral clomiphene citrate, and 43 (23%) of 191 with unstimulated intrauterine insemination. These results were not statistically significantly different between groups. The odds ratio (OR) for live birth was 0.79 (95% confidence interval [CI], 0.45 - 1.38) after clomiphene citrate and 1.46 (95% CI, 0.88 - 2.43) after unstimulated intrauterine insemination vs expectant management.
The process of treatment was considered acceptable by more women assigned to clomiphene citrate (159/170 [94%]; P = .001) and unstimulated intrauterine insemination (155/162 [96%]; P < .001) vs those assigned to expectant management (123/153 [80%]).
"In couples with unexplained infertility existing treatments such as empirical clomifene and unstimulated intrauterine insemination are unlikely to offer superior live birth rates compared with expectant management," the study authors write.
Limitations of this study include possible clinical heterogeneity related to the inclusion of cases of mild male factor infertility and minimal endometriosis; lack of generalizability to other populations and alternative drug regimens, particularly a combined approach with clomiphene citrate and intrauterine insemination, which the authors suggest should be a focus of future trials; lack of demographic information on those women who did not agree to participate in this trial; and debatable criteria for the diagnosis of "true" unexplained infertility.
"Spontaneous live birth rates in a randomised cohort of women with unexplained infertility do not seem to be enhanced by common first line treatments — clomifene citrate or unstimulated intrauterine
insemination," the study authors conclude. "These results challenge current
practice, as endorsed by a national guideline in the UK."
In an accompanying editorial, Tarek A El-Toukhy, MD, MRCOG, and Yacoub Khalaf, MD, from Guy's and St Thomas' Hospital National Health Service Foundation Trust, note that despite the prevalence of unexplained
infertility, good-quality evidence on various treatment interventions is lacking.
"Older age, a longer duration of infertility, and lack of pregnancy after expectant management should be regarded as indications for a more proactive treatment plan,"
Drs. El-Toukhy and Khalaf write. "Admittedly, the choice of the precise first line treatment will need to be individualised according to the patient's
expectations, the centre's experience, and available resources. However, on the basis of the best evidence
available, in vitro fertilisation seems to be the most cost effective
intervention."
BMJ 2008;337:a716
(Augustus
2008)
Deze problematiek die steeds vaker voorkomt heeft veel te maken met milieuvervuiling waardoor onze endocriene systemen beïnvloed worden en de doorgaans minder goede voedingsgewoontes. Belangrijk daarom is gezonde voeding te nemen en zonodig aan te vullen als u in verwachting wilt raken.