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Chapter 6 - Unexplained Infertility

Published online by Cambridge University Press:  25 February 2021

By
Ben Willem Mol  and
Andrew William Nguyen
Edited by
Siladitya Bhattacharya  and
Mark Hamilton
Siladitya Bhattacharya
Affiliation:
University of Aberdeen
Mark Hamilton
Affiliation:
University of Aberdeen
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Summary

Unexplained infertility refers to the inability to conceive within 12 months of unprotected intercourse, not attributable to any known causes of infertility such as ovulatory dysfunction, reduced sperm quality, tubal pathology or other causes. Treatment for unexplained infertility can be done predominantly through intrauterine insemination with or without hyperstimulation or in vitro fertilisation. Given that these treatments are utilised to improve likelihood of conception in relation to the couple’s chances of spontaneous pregnancy, rather than targeting any specific pathology, a comparison should be drawn between these treatments and their natural conception prognosis. Utilisation of prognostic models can allow differentiation between those likely to benefit from immediate treatment from such individuals who have reasonable natural conception prognosis and thereby can delay treatment for 6 months in hopes of spontaneous pregnancy. This comparison is valuable given the aforementioned treatments have implications for both the woman and her future child, and the cost of such procedures also compromises care accessibility.

Keywords

unexplained infertilityintrauterine inseminationIn vitro fertilisationprognosisrandomised clinical trials
Type
Chapter
Information
Reproductive Medicine for the MRCOG , pp. 54 - 67
Publisher: Cambridge University Press
Print publication year: 2021

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References

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Further Reading

Bensdorp, AJ, van der Steeg, JW, Steures, P, Habbema, JDF, Hompes, PGA, Bossuyt, PMM, et al., CECERM Study Group. A revised prediction model for natural conception. Reprod Biomed Online. 2017 Jun;34(6):619e26.CrossRefGoogle ScholarPubMed
Farquhar, CM, Liu, E, Armstrong, S, Arroll, N, Lensen, S, Brown, J. Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial. Lancet. 2018;391:441e50.CrossRefGoogle ScholarPubMed
Goverde, AJ, McDonnell, J, Vermeiden, JP, Schats, R, Rutten, FF, Schoemaker, J. Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet. 2000;355:13e8.CrossRefGoogle ScholarPubMed
Hughes, EG, Beecroft, ML, Wilkie, V, Burville, L, Claman, P, Tummon, I, et al. A multicentre randomized controlled trial of expectant management versus IVF in women with Fallopian tube patency. Hum Reprod. 2004;19:1105e9.Google ScholarPubMed
Pandey, S, Shetty, A, Hamilton, M, Bhattacharya, S, Maheshwari, A. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update. 2012;18:485e503.CrossRefGoogle ScholarPubMed
Reindollar, RH, Regan, MM, Neumann, PJ, Levine, BS, Thornton, KL, Alper, MM, et al. A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertil Steril. 2010;94: 888e99.CrossRefGoogle ScholarPubMed
van der Steeg, JW, Steures, P, Eijkemans, MJC, Habbema, JDF, Hompes, PGA, Broekmans, FJ, et al. Pregnancy is predictable: a large-scale prospective external validation of the prediction of spontaneous pregnancy in subfertile couples. Hum Reprod. 2006;22:536e42.Google ScholarPubMed
Veltman-Verhulst, SM, Hughes, E, Ayeleke, RO, Cohlen, BJ. Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev. 2016;2:Cd001838.Google ScholarPubMed

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