Fertility treatment found to make pregnancy less likely

LITTLE Jensen Jance is by all accounts the perfect baby. At two weeks old, his mother reports he eats efficiently, settles well and is even allowing her some sleep.

Then again, it is possible that after five years of waiting for the child they desperately wanted, Guilia and Michael Jance are unusually positive new parents.

After tests did not reveal a reason why they could not conceive, they were offered Clomid, a hormone tablet that doctors thought corrected subtle problems with ovulation. But after three-month courses on two separate occasions, there was still no pregnancy.

That occurred only after the Sydney couple was referred for insemination directly into 39-year-old Mrs Jance's uterus using a specially prepared sperm sample from her husband, together with an injected hormone to super-charge the release of eggs.

"It feels fantastic," a besotted Mrs Jance said this week of finally being a mother. "It's just incredible to see him here. We can't stop looking at him."

The Jances' journey is in line with new results from British research that concluded Clomid was useless or worse for couples whose failure to conceive was unexplained, and that such people should move straight to in-vitro fertilisation (IVF) or other more high-tech methods.

The study, from five hospitals in Scotland, followed 580 couples who were randomly assigned either to receive no treatment beyond advice about the timing of intercourse, a course of Clomid, or the intrauterine insemination IUI) that finally helped the Jances, but without the ovary-stimulating injection.

Research leader Allan Templeton — the architect of Britain's fertility treatment policy, which requires couples to try low-tech methods before they can get access to publicly-funded IVF — found the IUI technique only slightly improved the chances of having a baby. Clomid actually seemed to reduce the chance of success.

The results — considered definitive because of the strong design of the study and the large number of participants — "challenge current practice", Professor Templeton wrote yesterday in medical journal BMJ.

Michael Chapman, the fertility specialist who treated the Jances, said about one-third of patients with unexplained infertility could achieve pregnancy with IUI provided they also received ovarian stimulation. The British work confirmed his own observation that, "unstimulated IUI is a waste of time," he said.

Professor Chapman, who is medical director of private clinic group IVF Australia, said the technique was a "stepping stone" for the majority of couples who would eventually need IVF, but it had the advantage of being less invasive. Clomid worked well for women with polycystic ovarian syndrome, a condition that suppresses ovulation, Professor Chapman said. But it was also widely prescribed for unexplained infertility, often by gynaecologists who could not offer patients IVF.

Mark Bowman, medical director of Sydney IVF, said he preferred to move straight to IVF after a couple had waited adequate time to conceive spontaneously. Insemination combined with ovary stimulation, "is almost as invasive as IVF but there is a much higher multiple pregnancy rate," which often meant health problems for the resulting twins and triplets, he said.