Professor Cynthia Farquhar
Professor Cynthia Farquhar
An Auckland academic and fertility specialist whose research could revive support for a fertility treatment that’s less invasive than IVF, has just received a top honour from the Health Research Council of New Zealand (HRC).
 
Professor Cynthia (Cindy) Farquhar, postgraduate professor of Obstetrics and Gynaecology at the University of Auckland and consultant clinician at Fertility Plus and National Women’s  at the Auckland District Health Board, was last night awarded the HRC’s prestigious Liley Medal at the Royal Society Te Apārangi 2018 Research Honours Aotearoa held at Te Papa.
 
The Medal recognises her study into Intrauterine Insemination (IUI), published in The Lancet last November.
 
In a clinical trial, Professor Farquhar showed for the first time that IUI (a medical procedure to place sperm in the uterus) combined with ovarian stimulation (with either clomiphene or letrozole medication) was three times more effective than trying to conceive naturally in women with unexplained infertility and an unfavourable prognosis for natural conception.
 
Though IUI is widely used in New Zealand, the UK, USA and Europe as a less-invasive and less expensive alternative to in-vitro fertilisation (IVF), before now there had been little evidence of its success rate compared to ‘expectant management’ (when couples are advised to be sexually active around the likely time of ovulation for a chance of conceiving naturally). Consequently, in 2013 the UK National Institute for Health and Care Excellence (NICE) recommended that IUI should not be routinely offered for couples with unexplained infertility.
 
Professor Farquhar says the NICE recommendation will now be reconsidered as a result of  her team’s findings which prove that the treatment is worth continuing.
 
In the trial, 101 women receiving IUI treatment had 31 live births, compared with 9 live births for the 100 women assigned to ‘expectant management’. The study concluded that IUI could be offered as a safe and effective first-line strategy for couples with unexplained infertility. 
 
Professor Farquhar credits the breakthrough to the medication giving couples a helping hand by enabling more eggs to be released, and timing conception right by getting sperm into the uterus and thus halfway to the egg. 
 
She adds that IUI offers a simpler type of fertility treatment than IVF, which is more complicated but thought by many to be more effective. 
 
In New Zealand, couples with unexplained infertility who are eligible for publicly-funded fertility treatment have the option of either one cycle of IVF-type treatment (or microsurgery on the fallopian tubes or testes if that’s more appropriate than IVF) or four cycles of IUI treatment. The next step for Professor Farquhar is to test the effectiveness of four cycles of IUI compared with IVF, to help determine the most effective first-line treatment for couples to consider.
 
The HRC’s chief executive, Professor Kath McPherson, says it’s imperative to keep testing and building the evidence that underpins clinical practices. “Professor Farquhar’s study has provided evidence in a field where less invasive and more affordable treatment options are very much needed.
 
“These findings are a significant advance in knowledge that could inform healthcare going forward, and help couples make better-informed decisions about treatment,” she says. 
 
Professor Farquhar has over 280 peer-reviewed publications. She is the past Chair of the Perinatal and Maternal Mortality Review Committee and currently coordinating editor of the Cochrane Gynaecology and Fertility Group as well as lead methodologist for the World Health Organization Fertility Guidelines in 2018-2019.