Treatment Strategies for Unexplained Infertility

2020 ◽  
Vol 38 (01) ◽  
pp. 048-054
Author(s):  
Rui Wang ◽  
Rik van Eekelen ◽  
Monique H. Mochtar ◽  
Femke Mol ◽  
Madelon van Wely
Keyword(s):  
Ovarian Stimulation ◽  
Intrauterine Insemination ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Expectant Management ◽  
Unexplained Infertility ◽  
Vitro Fertilization ◽  
Standard Clinical Practice ◽  
Common Diagnosis

AbstractUnexplained 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.

A Randomized Clinical Trial to Evaluate Optimal Treatment for Unexplained Infertility

2021 ◽  
pp. 246-250
Author(s):  
Stephanie Rothenberg ◽  
Joseph Sanfilippo
Keyword(s):  
Ovulation Induction ◽  
Treatment Approach ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Unexplained Infertility ◽  
Additional Benefit ◽  
Multiple Gestation ◽  
Time To Pregnancy ◽  
Vitro Fertilization

The treatment of unexplained infertility has traditionally been comprised of a stepwise treatment approach, first with ovulation induction combined with intrauterine insemination (IUI) and then with in vitro fertilization (IVF). Ovulation induction is first attempted with clomiphene citrate, and, if unsuccessful, injectable gonadotropins are used. The value of ovulation induction with injectable gonadotropins in couples with unexplained infertility has been questioned, however, given the high risk of multiple gestation and the increasing efficacy of IVF. To address this, the FASTT trial randomized couples with unexplained infertility to a treatment arm that either included or omitted gonadotropin/IUI. They found that an accelerated treatment approach that involved 3 cycles of clomiphene citrate/IUI and then progressed immediately to IVF resulted in a decreased time to pregnancy compared to the group who underwent gonadotropin/IUI for 3 cycles, as well as decreased cost per live birth. Therefore, it was concluded that treatment of couples with unexplained infertility with gonadotropin/IUI was of no additional benefit.

scholarly journals Current Management of Endometriosis –An Update

2015 ◽  
Vol 23 (2) ◽  
pp. 245-255
Author(s):  
Shikha Ganguly ◽  
Nazneen Begum ◽  
Sultana Afroj ◽  
Nasrin Akhter
Keyword(s):  
Medical Treatment ◽  
Early Stage ◽  
Intrauterine Insemination ◽  
Management Strategies ◽  
Expectant Management ◽  
Gnrh Analog ◽  
Current Management ◽  
Vitro Fertilization ◽  
Line Therapy

Endometriosis, defined as the presence of endometrial tissue outside the uterus, is a challenging condition associated with substantial morbidity. Theories on the cause of the disease include retrograde menstruation, coelomic metaplasia, altered immunity, stem cells, and genetics. Management of endometriosis must be individualized according to the desired treatment outcome, whether it is relief of pain, improvement of fertility, or the prevention of recurrence. For alleviation of endometriosis-associated pain, medical treatment is generally successful, with no medical agent being more efficacious than another in spite of significantly differing side-effect profiles. Surgical therapy has also been demonstrated to reduce pain scores in comparison with expectant management, although conservative surgery has been frequently associated with recurrence. Endometriois has been associated with infertility; however, the mechanisms by which it affects fertility are still not fully understood. For treatment of endometriosis-associated infertility, suppressive medical treatment has been proven to be detrimental to fertility and should be discouraged, while surgery is probably efficacious for all stages. Controlled ovarian hyperstimulation with intrauterine insemination is recommended in early-stage and surgically corrected endometriosis. Combined surgery with Gonadotropin-releasing hormone (GnRH) analog treatment has been proposed to be first-line therapy, followed by in vitro fertilization (IVF) as second-line therapy in advanced cases. This article reviews the proposed mechanisms of endometriosis pathogenesis, its current management strategies and its effects on fertility, and treatments of endometriosis-associated infertility.J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 245-255

scholarly journals Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 460
Author(s):  
Lidia Filip ◽  
Florentina Duică ◽  
Alina Prădatu ◽  
Dragoș Crețoiu ◽  
Nicolae Suciu ◽  
...  
Keyword(s):  
Intrauterine Insemination ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Follicular Development ◽  
Future Research ◽  
Genetic Profile ◽  
Vitro Fertilization ◽  
Emerging Therapies ◽  
Treatment Alternatives

Endometriosis represents a frequently diagnosed gynecological affliction in the reproductive timespan of women, defined by symptoms ranging from pelvic pain to infertility. A complex interplay between the genetic profile, hormonal activity, menstrual cyclicity, inflammation status, and immunological factors define the phenotypic presentation of endometriosis. To date, imaging techniques represent the gold standard in diagnosing endometriosis, of which transvaginal ultrasonography and magnetic resonance imaging bring the most value to the diagnostic step. Current medical treatment options for endometriosis-associated infertility focus on either stimulating the follicular development and ovulation or on inhibiting the growth and development of endometriotic lesions. Techniques of assisted reproduction consisting of superovulation with in vitro fertilization or intrauterine insemination represent effective treatment alternatives that improve fertility in patients suffering from endometriosis. Emerging therapies such as the usage of antioxidant molecules and stem cells still need future research to prove the therapeutic efficacy in this pathology.

scholarly journals Success rate of intrauterine insemination in patients with unknown infertility

2012 ◽  
Vol 69 (4) ◽  
pp. 301-307 ◽  
Author(s):  
Vladimir Jasovic ◽  
Emilija Jasovic-Siveska
Keyword(s):  
Success Rate ◽  
Negative Impact ◽  
Intrauterine Insemination ◽  
Unexplained Infertility ◽  
Mild Form ◽  
Vitro Fertilization ◽  
Group A ◽  
Group B ◽  
Twin Pregnancies

Background/Aim. Unknown cause of infertility exists in 10%-26% of couples with infertility problems. Treatment of these couples depends on the possibility of correcting the unidentified defect over time. Intrauterine insemination (IUI) and ovaluation stimulation are methods of choice in treatment of unexplained fertility, but if a woman is older than 37 years, in vitro fertilization (IVF) could be directly recommended. The aim of this research was to compare the success rate of pregnancies with IUI between the patients with unexplained infertility and the patients with mild form endometriosis. Methods. The study included on 50 patients diagnosed with mild form endometriosis (group A) and 50 patients with unknown cause infertility (group B). Using the same therapeutical protocol, human menopausal gonadothropin (hMG) stimulation and horionic gonadropin (hCG) induction were applied, as well as IUI. Results. The percentage of achieved ovulation was higher in the group B (p < 0.05). During the 3 simulated sequential periods 102 IUI were performed in the group A and 97 IUI in the group B. In the group A there were 6 single and 1 twin pregnancies sucesfully conceived (14%), while in group B there were 9 (18%) single pregnancies. Conclusion. The use of a combination of controled ovarian hyperstimulation and IUI is an effective, cheap and safe method for treating infertility couples, especially couples with unknown cause infertility. Mild form endometriosis, as etiological infertility factor, has a negative impact on IUI success rate.

Sign in / Sign up

Export Citation Format

Share Document