OBJECTIVE: To summarize the evidence for the use of commonly accepted fertility tests in subfertile women with ovulation problems. DESIGN: Systematic review. SETTING: Not applicable. PATIENT(S): The study population included women starting with clomiphene citrate (CC) as first-line treatment, women starting with second-line treatment if CC failed to result in pregnancy, and women starting with second-line treatment if CC failed to result in ovulation (CC resistant). INTERVENTION(S): Performance of a semen analysis or tubal patency test before or during treatment. MAIN OUTCOME MEASURE(S): Prevalence of abnormal tests as well as the diagnostic and prognostic performance of these tests. RESULT(S): Four studies reported on 3,017 women starting with CC as first-line treatment. The prevalence of male factor infertility was 10%, and in 0.3% of couples azoospermia was found (two studies). Semen parameters were not associated with pregnancy chance (one study). The prevalence of bilateral tubal disease was 4% (two studies). Three studies reported on 462 women starting with second-line treatment if CC failed to result in a pregnancy. Semen parameters were not predictive for pregnancy (one study). The prevalence of bilateral tubal disease in these women was 8% (three studies). Two studies reported on 168 CC-resistant women and total motile sperm count did not predict live birth (two studies). For all other outcomes, no studies were available. CONCLUSION(S): Data on the basic fertility workup in subfertile women with anovulation are scarce. Based on the available data, the workup should contain a semen analysis, and, for women who need to start second-line treatment if CC failed to result in pregnancy or women with CC resistance, assessment of tubal patency.
OBJECTIVE: To summarize the evidence for the use of commonly accepted fertility tests in subfertile women with ovulation problems. DESIGN: Systematic review. SETTING: Not applicable. PATIENT(S): The study population included women starting with clomiphene citrate (CC) as first-line treatment, women starting with second-line treatment if CC failed to result in pregnancy, and women starting with second-line treatment if CC failed to result in ovulation (CC resistant). INTERVENTION(S): Performance of a semen analysis or tubal patency test before or during treatment. MAIN OUTCOME MEASURE(S): Prevalence of abnormal tests as well as the diagnostic and prognostic performance of these tests. RESULT(S): Four studies reported on 3,017 women starting with CC as first-line treatment. The prevalence of male factor infertility was 10%, and in 0.3% of couples azoospermia was found (two studies). Semen parameters were not associated with pregnancy chance (one study). The prevalence of bilateral tubal disease was 4% (two studies). Three studies reported on 462 women starting with second-line treatment if CC failed to result in a pregnancy. Semen parameters were not predictive for pregnancy (one study). The prevalence of bilateral tubal disease in these women was 8% (three studies). Two studies reported on 168 CC-resistant women and total motile sperm count did not predict live birth (two studies). For all other outcomes, no studies were available. CONCLUSION(S): Data on the basic fertility workup in subfertile women with anovulation are scarce. Based on the available data, the workup should contain a semen analysis, and, for women who need to start second-line treatment if CC failed to result in pregnancy or women with CC resistance, assessment of tubal patency.
Authors: Stefan Ghobrial; John Preston Parry; Iris Holzer; Judith Aschauer; Clara Selzer; Andreas Brezina; Samir Helmy-Bader; Johannes Ott Journal: J Clin Med Date: 2022-09-23 Impact factor: 4.964