After the last time I posted about this, a lot of you commented about how IUI had been the right treatment for you, and how at least it was affordable in the US, unlike IVF for many people. Also, a couple of you had diagnoses where IUI was the appropriate treatment - medium-level sperm issues, a lack of cervical mucous, etc. I am fairly sure that this study excludes those factors so read on.
A study published today shows that for those with UNEXPLAINED infertility, treatment with either IUI or clomid had no discernable effect. The doctor on the BBC news this morning pointed out that if you aren't ovulating, then clomid is an appropriate treatment. If you are, it has no effect on your chances of becoming pregnant. Here are the details:
In the six-month study, participants had all suffered unexplained fertility problems for more than two years.
Overall, 101 women ended up having a successful pregnancy.
Of those who tried to conceive naturally, 17% became pregnant and gave birth to a live baby.
For clomid, the birth rate was 14%, and insemination 23% - not significantly different from the chances of success with no intervention.
However, the women undergoing active treatment were more reassured.
The last sentence tells you why doctors keep on prescribing clomid and IUI when they are not specifically indicated. It's very hard to tell a patient to go away and do nothing, or that they are better off with IVF when, in most places in the UK, the local health authority will have a 2-3 year waiting list for IVF and lots of restrictions about who can be enrolled on the list. Or in the US because the patient may not be able or willing to take on the huge cost of IVF before they've "tried everything," or at all.
I'd like to look at the statistics for countries like Israel, where IVF is readily available and paid for by the state. Do more couples go straight to IVF, bypassing these intermediate and less effective treatments?
The thing to be careful about is asserting - IUI is the right treatment because it worked for me. This study shows that you are just as likely to have become pregnant by being sent away to keep going for six months as you are to have conceived with IUI, even if you've already been trying with no success for two years before that. It's just a probability game, and you happened to have hit the one month with IUI when you most likely would have achieved pregnancy without it. However, this is only true if you have unexplained infertility, not if you have a specific condition where IUI can help.
It makes sense if you say - I couldn't bear doing nothing any more, and IUI was the affordable option. That's a personal choice, not about the statistics. It's of course fine to say, we couldn't afford IVF so we went for IUI, but it actually is probably not a good use of your money - you could have saved the money you spent on IUI and spent it on something unrelated to fertility treatment.
Clomid is a bit of a different story - most people hate taking it and it can actively inhibit fertility by drying up cervical mucous. If you are ovulating, it really really should not be given to you. It's just a nonsense treatment.
So the point here is that the numbers by no means tell the whole story. They don't tell the story of how bloody miserable it is to try every month to no avail. At least by taking clomid or doing an IUI you feel like you are taking action to deal with this horrible problem. They also don't tell the story of the money flows in infertility - the intense rationing of IVF in the UK, the extraordinary cost for those in the US whose insurance doesn't cover IVF. Numbers are powerful but not omnipotent. Everyone has to make the decision that's right for them. I just wish the doctors and the insurance companies and the NHS would review their standard procedures and at least start having these conversations with people.