Guidelines on management of infertility in tertiary care were issued by the Royal College of Obstetricians and Gynaecologists this month. The evidence-based guidelines contain 42 recommendations for practice, the cost consequences of which are likely to be mixed, they say.
In relation to drug therapy, patient acceptability, costs and drug availability should be considered when choosing a gonadotrophin regimen, the guidelines say. They recommend the use of gonadotrophin-releasing hormone (GnRH) in addition to gonadotrophin stimulation in in vitro fertilisation (IVF) because it results in higher pregnancy rates. So far as gonadotrophins are concerned, pregnancy rates could be increased by the use of urinary derived, high purity preparations in preference to human menopausal gonadotrophin preparations. Natural cycle and clomiphene-stimulated IVF have a poor success rate, the guidelines state. Better outcomes are seen by using recombinant follicle stimulating hormone (FSH) which produces more oocytes in an IVF cycle than if gonadotrophin is used. Recombinant FSH also produces a higher pregnancy rate in embryo replacement than gonadotrophin.
Men undergoing medical treatment likely to make them infertile should be made aware of the possibility of semen cryostorage, the guidelines say. Local protocols should be in place so that health professionals are aware of the benefits of semen cryostorage, they add.
The guidelines complete a series of three which cover the management of infertility in primary, secondary and tertiary care. Further information can be obtained on the college's website (www.rcog.org.uk).