BACKGROUND: Unexplained infertility is one of the most common diagnoses in fertility care. The aim of this study was to evaluate the outcome of current fertility management in unexplained infertility. METHODS: In an observational, longitudinal, multicentre cohort study, 437 couples were diagnosed with unexplained infertility and were available for analysis. They were treated according to their prognosis using standing national treatment protocols: (i) expectant management-IUI-IVF (main treatment route), (ii) IUI-IVF and (iii) directly IVF. Primary outcome measures were: ongoing pregnancy rate, patient flow over the strategies, numbers of protocol violation and drop out rates. A secondary outcome measure was the prediction of ongoing pregnancy and mode of conception. RESULTS: Of all couples 81.5% (356/437) achieved an ongoing pregnancy and 73.9% (263/356) of the pregnancies were conceived spontaneously. There were 408 couples (93.4%) in strategy-1, 21 (5.0%) in strategy-2 and 8 (1.8%) in strategy-3. In total, 33 (7.6%) couples entered the wrong strategy. There were 104 couples (23.8%) who discontinued fertility treatment prematurely: 26 on doctor's advice (with 4 still becoming pregnant) and 78 on their own initiative (with 33 still achieving a pregnancy). Predictors for overall pregnancy chance and mode of conception were duration of infertility, female age and obstetrical history. CONCLUSIONS: Overall success rate in couples with unexplained infertility is high. Most pregnancies are conceived spontaneously. We recommend that if the pregnancy prognosis is good, expectant management should be suggested. The prognosis criteria for treatment with IUI or IVF needs to be investigated in randomized controlled trials.
BACKGROUND:Unexplained infertility is one of the most common diagnoses in fertility care. The aim of this study was to evaluate the outcome of current fertility management in unexplained infertility. METHODS: In an observational, longitudinal, multicentre cohort study, 437 couples were diagnosed with unexplained infertility and were available for analysis. They were treated according to their prognosis using standing national treatment protocols: (i) expectant management-IUI-IVF (main treatment route), (ii) IUI-IVF and (iii) directly IVF. Primary outcome measures were: ongoing pregnancy rate, patient flow over the strategies, numbers of protocol violation and drop out rates. A secondary outcome measure was the prediction of ongoing pregnancy and mode of conception. RESULTS: Of all couples 81.5% (356/437) achieved an ongoing pregnancy and 73.9% (263/356) of the pregnancies were conceived spontaneously. There were 408 couples (93.4%) in strategy-1, 21 (5.0%) in strategy-2 and 8 (1.8%) in strategy-3. In total, 33 (7.6%) couples entered the wrong strategy. There were 104 couples (23.8%) who discontinued fertility treatment prematurely: 26 on doctor's advice (with 4 still becoming pregnant) and 78 on their own initiative (with 33 still achieving a pregnancy). Predictors for overall pregnancy chance and mode of conception were duration of infertility, female age and obstetrical history. CONCLUSIONS: Overall success rate in couples with unexplained infertility is high. Most pregnancies are conceived spontaneously. We recommend that if the pregnancy prognosis is good, expectant management should be suggested. The prognosis criteria for treatment with IUI or IVF needs to be investigated in randomized controlled trials.
Authors: Rui Wang; Nora A Danhof; Raissa I Tjon-Kon-Fat; Marinus Jc Eijkemans; Patrick Mm Bossuyt; Monique H Mochtar; Fulco van der Veen; Siladitya Bhattacharya; Ben Willem J Mol; Madelon van Wely Journal: Cochrane Database Syst Rev Date: 2019-09-05
Authors: A J Bensdorp; R I Tjon-Kon-Fat; P M M Bossuyt; C A M Koks; G J E Oosterhuis; A Hoek; P G A Hompes; F J M Broekmans; H R Verhoeve; J P de Bruin; R van Golde; S Repping; B J Cohlen; M D A Lambers; P F van Bommel; E Slappendel; D Perquin; J M Smeenk; M J Pelinck; J Gianotten; D A Hoozemans; J W M Maas; M J C Eijkemans; F van der Veen; B W J Mol; M van Wely Journal: BMJ Date: 2015-01-09
Authors: Rivka Koedooder; Martin Singer; Sam Schoenmakers; Paul Hendrik Maria Savelkoul; Servaas Antonie Morré; Jonathan Dennis de Jonge; Linda Poort; Willem-Jan Simon Stephanus Cuypers; Andries Edward Budding; Joop Stephanus Elisabeth Laven Journal: Reprod Health Date: 2018-12-07 Impact factor: 3.223
Authors: Felicia Dreischor; Ellen T M Laan; Fleur Peeters; Karen Peeraer; Cornelis B Lambalk; Mariëtte Goddijn; Inge M Custers; Eline A F Dancet Journal: Hum Reprod Open Date: 2022-09-15