Delving Into the Mysteries of Unexplained Infertility

Some standard treatments don't help, a study finds, underscoring how much is still unknown.

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I can't say I'm too surprised by a new study showing that certain low-tech fertility treatments don't work for women with unexplained infertility. Much is still unknown about what it takes to achieve a successful pregnancy; in fact, for one third of couples who can't get pregnant after a year of trying, there's no apparent medical explanation. The new study, published in the British Medical Journal, randomly assigned some women with unexplained infertility to take the ovulation-stimulating drug clomiphene citrate (Clomid) and others to undergo artificial insemination. A third group of such women just went for regular doctor visits. In the end, all three groups had the same likelihood of giving birth to a child.

What's shocking, though, is how common it is for infertile women to be given treatments that haven't been rigorously tested for effectiveness. "As a direct result of lack of evidence, many couples with unexplained infertility endure [and even request] expensive, potentially hazardous, and often unnecessary treatments," reproductive medicine specialists Tarek El-Toukhy and Yacoub Khalaf write in an editorial that appears in BMJ. Clomid, for example, increases the risk of twins and triplets and could potentially increase the risk of ovarian cancer in those who take it for several months.

And while it's certainly understandable for doctors to recommend less invasive and cheaper methods before in vitro fertilization (which costs upwards of $12,000 per cycle), they may be doing women a huge disservice. Those under 35 could be better off trying to get pregnant on their own—at least for a few more months—while older women may want to avoid wasting precious time and head straight to IVF or adoption.

Even when infertility has an explainable cause, treating it is sometimes more art than science. I speak from personal experience, having always had extremely irregular periods—on average twice a year—due to polycystic ovarian syndrome. I was told my chances of getting pregnant on my own were slim. When my husband and I decided to have a baby, my doctor prescribed Clomid to induce ovulation. First, as part of standard protocol, I had to take a progesterone pill, Provera; somehow, I'd become pregnant. My doctor scratched her head and said it must be a coincidence, since Provera isn't supposed to induce ovulation. I took her word for it until I got pregnant with my second child—once again, after taking Provera to prepare for a cycle of Clomid.

A friend of mine has a similar story of getting pregnant when she wasn't supposed to. Six years ago, at age 40, she'd forked over thousands of dollars on IVF treatments before being told that her hormone levels indicated that her eggs were too old to make healthy embryos. She searched around on the Internet and found a doctor in New Jersey willing to work with "long-shot" patients. She took a chance because, in her heart, she didn't feel like she was ready to give up trying. She tells me this as we sit in her backyard observing the results of her gut decision: Her blond, 5-year-old twins streak by, chasing each other in a game of tag.

Here's the best approach for overcoming infertility.