In a story featuring a photo of a lovely couple holding a beautiful newborn, the Globe and Mail (a reputable Canadian national newspaper) has an article this week about using Robitussin as a fertility aid. According to the article, the TTC (trying to conceive) community is abuzz with this.

How an off-label application of over-the-counter cold medicine found a shelf life as a conception tool widely promoted online is a story marked with skepticism and disbelief. Robitussin’s effectiveness has been debated on chat forums, and references to its impact can be found in bestselling pregnancy books. In a time when fertility treatments cost thousands of dollars, it’s not surprising that a $5 solution has intrigued women for more than 20 years. But it is unusual that despite almost three decades of word-of-mouth debate, there’s little scientific evidence to prove that it works – or that it doesn’t – leaving it in a strange realm somewhere between old wives’ tale and unsung miracle drug.

The article later describes the published support for the active ingredient in aiding conception:

A Pennsylvania doctor, Jerome Check, published an article called “Improvement of cervical factor with guaifenesin” in the Journal of Fertility and Sterility in 1982. It documented a study of 40 couples who had been attempting unsuccessfully to conceive for at least 10 months.

The women were given 200 milligrams of guaifenesin three times a day, from the fifth day of menstruation through to ovulation. Dr. Check found that 23 of the women showed “marked improvement in postcoital tests after treatment, while seven showed slight improvement,” meaning that their cervical mucus was noticeably thinner.

More important, of those 23 couples, Dr. Check wrote that 15 became pregnant while testing the regimen. One patient with only mild improvement in her mucus levels also conceived. Dr. Check concluded that guaifenesin is “one of the simplest and cheapest treatment methods of addressing the cervical factor.”

I see that JH Check has published 3 further articles mentioning guaifenesin fertility, but he is a lone voice, aside from the TTC community of women, and some authors of lay books on becoming pregnant. A spokeswoman for the manufacturer said in e-mail, “We do not have any data for the use of Mucinex [the US product name] for fertility issues nor do we recommend its use for this purpose.” There’s no pharmaceutical interest driving (and funding) the research, so individual researchers need to somehow fund this themselves (would a national health granting agency fund such work?).

And apparently things like the quality of cervical mucous (which is part of how oral contraceptives block pregnancy) are no longer relevant, because

… the medical community has moved on, propelled by advances in technology that have seen in-vitro fertilization become standard treatment for fertility problems. “Cervical mucus can be overcome by doing insemination, so it doesn’t even matter,” Dr. Cheung said of Robitussin’s possible effect.

The article also describes the serious issues with ethics of research on infertility treatments, given the desperation of people seeking help:

“We see people who come to the support group who seem to be rushed into IVF without a real assessment,” she [Diane Allen, who runs the Canada-based Infertility Network] said. “They feel so desperate that if somebody told them to stand in the corner or cut off their arm or something – if they thought they’d have a child out of it – maybe they’d do it.”

The journal Human Reproduction recently published a Dutch study that followed a cohort of 1391 couples through the process of fertility care. They found that 319/1391 couples dropped out, the majority citing emotional distress, poor prognosis, or an unwillingness to do what it took to follow through with the treatment. Of those couples, 10% had a spontaneous pregnancy after discontinuing treatment.

Certainly I’ve met women who were immediately given shots to induce ovulation before being taught to chart their menstrual cycle. I have a friend who discovered that she ovulated typically on day 18, but had been trying to conceive on day 14. For several cycles, she and her partner had exhausted themselves too early, and were missing their fertility window. Once she found that out, all was good.

I don’t want to diminish the difficulties of not making a baby when you want one. It can be extremely painful, and hard on the relationship of the couple hoping to conceive. And I have no idea whether the active ingredient, guaifenesin, works. An obgyn friend of mine commented that it would be helpful for women who have abnormal mucous, but that’s a small proportion of the couples with subfertility issues. I also don’t know whether there are medical concerns about using it daily for this purpose. If I were a drug manufacturer, I’d also be worried about promoting something with such a tiny profit margin, likely no patentability, and unknown effects on the babies conceived following its use. In fact, a product sought out by people having trouble conceiving might tend to attract people who were more likely to have babies with problems, so there’s the real possibility of a public relations disaster that had nothing to do with actual risks. So I might back away from the whole area, saying “no comment”, and hoping that the internet buzz would continue.