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Semin Reprod Med 2020; 38(01): 048-054
DOI: 10.1055/s-0040-1719074
Review Article

Treatment Strategies for Unexplained Infertility

Rui Wang 
1   Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
,
Rik van Eekelen 
2   Centre for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
,
Monique H. Mochtar 
2   Centre for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
,
Femke Mol
2   Centre for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
,
Madelon van Wely 
2   Centre for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands
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Abstract

Unexplained infertility is a common diagnosis among couples with infertility. Pragmatic treatment options in these couples are directed at trying to improve chances to conceive, and consequently intrauterine insemination (IUI) with ovarian stimulation and in vitro fertilization (IVF) are standard clinical practice, while expectant management remains an important alternative. While evidence on IVF or IUI with ovarian stimulation versus expectant management was inconclusive, these interventions seem more effective in couples with a poor prognosis of natural conception. Strategies such as strict cancellation criteria and single-embryo transfer aim to reduce multiple pregnancies without compromising cumulative live birth. We propose a prognosis-based approach to manage couples with unexplained infertility so as to expose less couples to unnecessary interventions and less mothers and children to the potential adverse effects of ovarian stimulation or laboratory procedures.

Keywords

unexplained infertility - expectant management - intrauterine insemination - in vitro fertilization - cost-effectiveness - safety


Publication History

Article published online:
29 October 2020

© 2020. Thieme. All rights reserved.

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