Effectiveness and treatment for unexplained infertility

Abstract

Up to 30% of couples who are unable to conceive are eventually determined to have unexplained infertility (1). Traditionally, this diagnosis is made only after the basic infertility evaluation fails to reveal an obvious abnormality. The basic evaluation should provide evidence of ovulation, adequate sperm production, and fallopian tube patency. It remains unclear whether the basic infertility assessment also should test for antisperm antibodies, adequate cervical mucus production, timely development of secretory phase endometrial responses, presence of adhesions, and evidence of pelvic endometriosis. At present, even the most sophisticated diagnostic assessment cannot reveal all of the possible abnormalities. Therefore unexplained infertility appears to represent either the lower extreme of the normal distribution of fertility, or it arises from a defect in fecundity which cannot be detected by the routine infertility evaluation (2). Couples with unexplained infertility suffer from both diminished and delayed fecundity, compared with the 20% to 25% that would be expected in normal fertile couples. In a review of unexplained infertility studies, the average cycle fecundity in the untreated control groups was 1.8% in 11 non-randomized studies and 3.8% in six randomized studies (3). Pregnancy rates are lower with increasing age of the female partner and duration of infertility (4).