'Fast-track' IVF saves time and lowers risks

Fertility patients could save time and money by skipping some recommended steps in treatment and going straight to IVF, according to a new study. This would mean that couples with fertility problems would not lose precious time in conceiving a child.

Women who skipped the rounds of artificial insemination with hormone treatment, recommended in the US, and went straight to IVF became pregnant 30% faster than their counterparts following traditional US protocols. The researchers now say that doctors should abandon the use of artificial insemination combined with direct hormone treatment.

In countries such as the US, doctors recommend that women seeking fertility treatment follow a three-step process. The first part involves receiving a drug called Clomid, which boosts egg production, and then injecting sperm into the body through artificial insemination. One cycle of this treatment has a 6% to 9% success rate.

Doctors typically attempt three cycles of artificial insemination with Clomid. If this fails, they move to the next step – artificial insemination in combination with "follicle stimulating" hormone (FSH).

Dangerous pregnancies

The administration of FSH ramps up egg production far beyond Clomid, and for this reason, use of the hormone often results in dangerous triplet pregnancies. This method has an estimated success rate of 9% to 15%. If three such cycles fail to work, women receive in-vitro fertilisation (IVF) treatment as a last resort.

Because of the unpredictable risk of dangerous triplet and quadruplet pregnancies with FSH-based artificial insemination, some fertility clinics have started skipping this step and going straight to IVF if the Clomid treatment fails.

"More and more couples are skipping the middle step or going directly to IVF," says Richard Reindollar of the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, US. But experts have remained unsure whether this "fast-tracked" IVF is a wise move.

'No benefit'

So Reindollar and colleagues studied the outcome of 503 couples with unexplained infertility who were randomly assigned to either the three-step process or the "fast-tracked" two-step process.

They found that both groups had a similar success rate – while 185 (75%) of the couples receiving conventional treatment achieved pregnancy, 199 (78%) of those assigned to the fast-track protocol achieved pregnancy.

Moreover, the fast-track couples had a 40% better chance of achieving pregnancy in the first year of treatment than those undergoing standard treatment. And while the latter group took 11 months and $71,399 on average to produce pregnancy, this happened within eight months – 30% faster – for couples who skipped the middle step, and cost $61,553 on average.

According to Reindollar, the results show that artificial insemination combined with FSH "does not provided added benefit over an accelerated approach that eliminates this treatment".

"It pretty definitively shows that there's no benefit from this middle step," comments Evan Myers at the University of North Carolina School of Public Health in Chapel Hill, North Carolina.

Reindollar says his study – the first to prospectively investigate the impact of fast-tracked IVF – should prompt clinics to skip FSH-based artificial insemination and thereby reduce the risk of complicated triplet pregnancies. He admits that IVF can also carry an elevated risk of triplet pregnancies, but stresses that this can be avoided by transferring fewer embryos.

The findings were presented at the annual meeting of the American Society for Reproductive Medicine in Washington, DC, US on Thursday.

Source: http://www.newscientist.com/article/dn12803-fasttrack-ivf-saves-time-and-lowers-risks.html

Category: Clomid, FSH, infertility, IVF