Helix Clinic blog

An interesting paper was published in 2008 in the BMJ, by Bhattacharaya et. al., that raises questions about the effectiveness of two of the most commonly used treatments for couples with unexplained infertility (a quarter of all couples with fertility problems have unexplained infertility).

Clomifene (or Clomid) is a medicine that stimulates a woman’s ovaries to produce more eggs, and IUI (intrauterine insemination) is a procedure that involves injecting sperm directly into the womb. Both of these treatments are currently endorsed in the UK by the NICE fertility guidelines for couples with unexplained infertility.

The research paper is interesting because it suggests that these treatments are no more effective than waiting for 6 months without treatment. The likelihood of falling pregnant during the study’s 6 month period was the same for all couples, whether they had one of the treatments or not.

The research is convincing because it included 580 couples and adhered to the strict standards of a randomised controlled trial, making it one of the largest good quality studies of this type of infertility. So if you have unexplained infertility and have been offered clomifene or IUI, it would be worth mentioning this study to your consultant and asking why they think this treatment would be relevant for you.

Tags: clomid, clomifene, infertility, IUI

AMH stands for Anti-Mullerian Hormone, which is produced directly by the ovarian follicles. AMH levels correlate with the number of antral follicles present in the ovaries , so women with lower AMH  have lower antral follicular counts compared to women with higher levels.

Antral follicles are small follicles (about 2-8 mm in diameter) that can be seen, measured and counted with ultrasound. Antral follicles are also referred to as resting follicles, and according to some fertility clinics, the antral follicle count (in conjunction with female age) is the best test for estimating ovarian reserve and/or chances for pregnancy with IVF. The day 3 FSH levels are also important.

AMH levels are considered optimal between 28.6 pmol/L - 48.5 pmol/L, satisfactory between 15.7 pmol/L - 28.6 pmol/L and low between 2.2 pmol/L - 15.7 pmol/L. They do not vary through the menstrual cycle and can be measured on any day.

Because AMH levels correlate with the number of early antral follicles, they is useful for prediciting ovarian response in an IVF cycle. Women with low AMH levels are more likely to be poor ovarian responders.

The AMH test can also give a measure of ovarian aging – women with poor ovarian reserves generally have low levels of AMH. The AMH test is fairly new, expensive and not always available, which is why the gold standard for ovarian reserve testing is still the day 3 FSH test.

Tags: AMH, Anti-Mullerian hormone, antral follicles, FSH, infertility, IVF

Once in a while, we see patients who are going through IVF and are having difficulty with their fertility clinics or consultants. They may feel that their consultant doesn’t sufficiently answer all their questions and concerns, or sometimes they find their consultant to be quite cold and aloof. Since they are paying a lot of money for the treatment, this can lead to bad feeling.

If the cycle is unsuccessful it is not surprising that patients can feel unconfident about starting a new cycle with the same clinic or consultant. Often the main issue stopping someone change clinics is a financial one, and the clinic that they might like to go to seems above budget.

In our experience, when this situation arises patients often like to talk about it with us, and our advice stems from thinking about the whole IVF treatment in holistic terms. An IVF cycle is a very stressful process, partly because everything seems to move so slowly. Frustrations or worries can easily build up, which in turn puts the physical body under more stress. Lack of confidence in a clinic or consultant is an unnecessary extra source of stress that could negatively affect the outcome of the cycle.

Our advice would be to find a consultant and clinic that make you feel as confident as you can that they are doing a good job. It may cost more money, but the peace of mind you will gain is far more important in the long run. Based on our experience watching many women go through IVF, we are convinced that if a patient can find a clinic that they feel happy with, the chances of a successful cycle improve.

Tags: infertility, IVF