Demographics of infertility and management of unexplained infertility

The cause of infertility is unexplained in about 22–28% of all infertile couples. The prognosis for spontaneous pregnancy in such couples is better than in those with diagnosed causes of infertility. Traditional treatment options in this group have included expectant management, clomifene citrate, i...

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Bibliographic Details
Published in:Best practice & research. Clinical obstetrics & gynaecology 2012-12, Vol.26 (6), p.729-738
Main Authors: Kamath, Mohan S., MS, DNB, Bhattacharya, Siladitya, MD, FRCOG
Format: Article
Language:English
Subjects:
Birth Rate
clomifene citrate
Clomiphene - therapeutic use
expectant management
Female
Fertility Agents, Female - therapeutic use
Fertilization in Vitro
Humans
in-vitro fertilisation
Infertility - diagnosis
Infertility - etiology
Infertility - therapy
Insemination, Artificial
intra uterine insemination
Male
Obstetrics and Gynecology
Pregnancy
Pregnancy Rate
Pregnancy, Multiple
Prognosis
Reproductive Techniques, Assisted
super ovulation
Superovulation
unexplained infertility
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Summary:The cause of infertility is unexplained in about 22–28% of all infertile couples. The prognosis for spontaneous pregnancy in such couples is better than in those with diagnosed causes of infertility. Traditional treatment options in this group have included expectant management, clomifene citrate, intrauterine insemination with (super ovulation plus intrauterine insemination) or without (intrauterine insemination) super ovulation and in-vitro fertilisation. Despite being more expensive, empirical clomifene and intrauterine insemination in an unstimulated cycle do not improve the chances of live birth compared with expectant management. Although unlikely to be more effective than no treatment in couples with a reasonably good prognosis, super ovulation plus intrauterine insemination has been shown to be more effective than intrauterine insemination. Any potential advantage of super ovulation plus intrauterine insemination has to be balanced against the relatively high risk of iatrogenic multiple pregnancy. In-vitro fertilisation remains the treatment of choice in longstanding unresolved infertility and, when coupled with the use of elective single embryo transfer, can minimise the risk of multiple pregnancies. Data from randomised trials confirming the superiority of in-vitro fertilisation over expectant management is limited.
ISSN:1521-6934
1532-1932
DOI:10.1016/j.bpobgyn.2012.08.001