title: A multicentre randomized controlled trial of expectant management versus IVF in women with Fallopian tube patency.
abstract: BACKGROUND
  Although observational studies suggest that IVF is more effective than no treatment for women with Fallopian tube patency, this has not been tested rigorously in a randomized controlled trial (RCT).
  
  
  METHODS
  Eligible consenting couples planning their first treatment cycle in five Canadian fertility clinics received either IVF, within 90 days of randomization, or a period of 90 days with no treatment. Random allocation was stratified by female age and sperm quality, and administered using numbered, opaque, sealed envelopes. Follow-up assessed live birth and associated morbidity.
  
  
  RESULTS
  Sixty-eight couples were randomized to a first cycle of IVF and 71 couples had 3 months without treatment. The live birth rates were 20/68 (29%) and 1/71 (1%), respectively. The single delivery in the untreated group was of twins, as were six of the 20 IVF deliveries (30%). An average of 2.0 embryos were transferred and no triplet pregnancies resulted. The relative likelihood of delivery after allocation to IVF was 20.9-fold higher than after allocation to no treatment [95% confidence interval (CI) 2.8-155]. The presence of abnormal sperm did not reduce this likelihood. Treating four women (95% CI 3-6) with one cycle of IVF is required to achieve a single additional birth.
  
  
  CONCLUSIONS
  This study provides a valid and up-to-date comparison for policy makers and patients as they make choices around IVF, accurately measuring and confirming a major benefit from treatment.
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada. hughese@mcmaster.ca
authors.forename: E G
authors.initials: EG
authors.lastname: Hughes
authors.forename: M L
authors.initials: ML
authors.lastname: Beecroft
authors.forename: V
authors.initials: V
authors.lastname: Wilkie
authors.forename: L
authors.initials: L
authors.lastname: Burville
authors.forename: P
authors.initials: P
authors.lastname: Claman
authors.forename: I
authors.initials: I
authors.lastname: Tummon
authors.forename: E
authors.initials: E
authors.lastname: Greenblatt
authors.forename: M
authors.initials: M
authors.lastname: Fluker
authors.forename: K
authors.initials: K
authors.lastname: Thorpe
mesh_terms: D001723:Birth Rate; D005186:Fallopian Tube Patency Tests; D005187:Fallopian Tubes / Q000502:physiology*; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome