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.

Infertility Treatment: Ovulation Induction and Insemination

2018 ◽  
Author(s):  
Quinton Katler ◽  
Jessica R Zolton ◽  
Alan H. DeCherney
Keyword(s):  
Ovulation Induction ◽  
Polycystic Ovarian Syndrome ◽  
Intrauterine Insemination ◽  
Semen Analysis ◽  
Clomiphene Citrate ◽  
Hypogonadotropic Hypogonadism ◽  
Unexplained Infertility ◽  
Male Factor ◽  
Ovarian Syndrome

For the majority of infertility patients, ovulation induction is the initial therapy. Treatment is individualized for a couple based on ovarian reserve testing, semen analysis, and the presence of anatomic pathology. Candidates for ovulation induction include those who are anovulatory and couples with unexplained infertility. The majority of patients diagnosed with anovulation have polycystic ovarian syndrome. Treatment options include clomiphene citrate and letrozole. For patients with hypogonadotropic hypogonadism, treatment involves injections with gonadotropins. Treatment is typically combined with intrauterine insemination to maximize pregnancy rates, especially in patients with male factor infertility or unexplained infertility. A stepwise approach is necessary, as patients who are unsuccessful with less invasive and costly treatments may eventually require in vitro fertilization. This review contains 7 figures, 3 tables and 57 references Key Words: clomiphene citrate, gonadotropins, infertility, intrauterine insemination, letrozole, ovulation induction, polycystic ovarian syndrome, unexplained infertility

scholarly journals A study for evaluation of two protocols comprising of clomiphene citrate, human menopausal gonadotropin with or without follicle stimulating hormone for ovulation induction in patients with infertility for intrauterine insemination

2019 ◽  
Vol 8 (6) ◽  
pp. 2487
Author(s):  
Ashok Verma ◽  
Shivani Sharma ◽  
Suresh Verma ◽  
Pankaj Sharma ◽  
Tenzin Tsamo Tenga ◽  
...  
Keyword(s):  
Menstrual Cycle ◽  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Clomiphene Citrate ◽  
Human Menopausal Gonadotropin ◽  
Multiple Gestation ◽  
Group A ◽  
Group B

Background: To compare two protocols comprising of FSH/CC/HMG and CC/HMG for ovulation induction and IUI in women with infertility.Methods: 60 women with unexplained infertility were randomized using sequentially numbered opaque envelope method. Group A received inj FSH 150 units on day 2 of menstrual cycle and clomiphene citrate 100 mg from day 3-7, followed by injection HMG 150 units on day 9 of menstrual cycle. Group B received clomiphene citrate 100 mg from day 3-7, and HMG 150 units on day 7 and 9 of the menstrual cycle.  Ovulation triggered with hCG 5000 units when dominant follicle was 18mm. Single IUI was done 36-42 hours afterwards.Results: Pregnancy occurred in 3 out of 30 women in 116 cycles Group A (with FSH) with a pregnancy rate of 10 percent, and 2.8% per cycle. In group B (without FSH) pregnancy occurred in 3 out of 30 women in 117 cycles with pregnancy rate of 10 percent, and 2.6% per cycle. The number of follicles per cycle was 1.36 and follicle size was 18.57 mm in group A. While in Group B numbers of follicles per cycle were 1.22, with average size of 18.9mm. Mean endometrial thickness was 7.7mm in Group A and 6.37 in Group B (p=.01, significant). Mild OHSS was observed in one woman in Group B. No other side effects were observed in both the groups.Conclusions: The controlled ovarian stimulation regimes used in this study are equally effective, easy to administer, require less intensive monitoring and fewer medications, with little risk of OHSS and multiple gestation.

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.

scholarly journals Using the EngagedMD multimedia platform to improve informed consent for ovulation induction, intrauterine insemination, and in vitro fertilization

2018 ◽  
Vol 110 (7) ◽  
pp. 1338-1346 ◽  
Author(s):  
Jody Lyneé Madeira ◽  
Jennifer Rehbein ◽  
Mindy S. Christianson ◽  
Miryoung Lee ◽  
J. Preston Parry ◽  
...  
Keyword(s):  
Informed Consent ◽  
In Vitro Fertilization ◽  
Ovulation Induction ◽  
Intrauterine Insemination ◽  
Vitro Fertilization
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