The options listed by the National Institute of Clinical and Health Excellence (NICE) include up to six cycles of unstimulated intrauterine insemination - where sperm is inserted directly into the woman's womb - and use of clomid (clomifene citrate), a drug which stimulates the ovaries.
The treatments have both been offered for many years because "doing nothing" is an unpopular choice among patients, the researchers said.
Five hospitals were involved in the study: Aberdeen Royal Infirmary, Edinburgh Royal Infirmary, Ninewells Hospital in Dundee, Falkirk and District Royal Infirmary and Glasgow Royal Infirmary. In the six-month study, participants had all suffered unexplained fertility problems for more than two years. 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.
Study leader, Professor Siladitya Bhattacharya, from the University of Aberdeen, said the findings challenge current practice. She added,
"The first thing is it sends a positive message that the chances of success spontaneously are pretty convincing."
Dr Allan Pacey, senior lecturer at the University of Sheffield and secretary of the British Fertility Society, said: "It is very important that we have a strong evidence base to support the treatments that are offered to infertile couples and as such this study is very valuable.
"Intrauterine insemination has been offered to couples with unexplained infertility for many years, but if there is no benefit in doing so then we should re-evaluate the clinical guidelines so that NHS money is used wisely."
August 2008
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