Saturday, 3 November, 2007

Fertility Injections - A Waste of Time?

New research found that hormone injections to achieve pregnancy do not 'provide any added benefit' financially or medically in women under 40 as an alternative infertility treatment before advancing to IVF, announced head researcher Dr Richard Reindollar, from the Dartmouth-Hitchcock Medical Centre in New Hampshire, last week at the annual meeting of the American Society for Reproductive Medicine in Washington last week. The comprehensive study indicates that the thousands of Indian women each year who receive follicle-stimulating hormone (FSH) injections costing Rs 20,000 - Rs 25,000 per course for infertility treatment before resorting to IVF treatment may actually be prolonging the time it takes to become pregnant at unnecessarily increased costs and health risks than if they were to undergo IVF treatment straight away.
In the study of 503 infertile couples, those who were 'fast-tracked' to IVF treatment became pregnant three months earlier than those couples who underwent the daily injections together with artificial insemination (IUI) before, if unsuccessful, undergoing IVF treatment, which also involves ovary-stimulating injections but is coupled with the more invasive egg
extraction and embryo implantation procedures. In practice, women typically begin treatment by trying clomiphene pills together with IUI and when that is unsuccessful most Indian and many UK clinics then offer a course of injections with IUI before performing IVF as a final treatment stage. Both groups were initially unsuccessful with pills and IUI and both had a similar chance of becoming pregnant. Ultimately 78 per cent of those fast-tracked and 75 per cent of those receiving injections were successful but the fast-tracked couples had a 40 per cent increased chance to become pregnant
within the first eight months versus eleven months of treatment, and saved overall costs by an average of £5,000- reducing average payment from £35,700 to £30,750.
Women may also be placing themselves at prolonged health risk. The injections stimulate the ovaries egg production and have significant physical side-effects including headaches, abdominal pain and ovarian hyperstimulation syndrome, which in extremely rare cases can be fatal. They also increase the risk of multiple births by 20 to 30 per cent, which in turn increases the risk of birth defects and pregnancy-induced hypertension. Contrary to National Institute for Health and Clinical Excellence guidance, which recommends the NHS pay for hormone injections only for women with endometriosis, many private clinics offer them more generally often in cases of unexplained infertility, according to Mark Hamilton, chairman of
the British Fertility Society. Infertility affects one in seven British couples and Hamilton urges patients to carefully consider with their doctors the efficacy of infertility treatments before attempting treatments with lower success levels. Bill Ledger, Professor of Obstetrics and Gynaecology at the University of Sheffield felt this study adds to mounting evidence in
support of the cost-saving elimination of injections and redirection of those funds into providing cheaper IVF treatment with an equal success rate without the delay.

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