O-204 Treatment of unexplained infertility: IUI for all?

Abstract

Abstract Study question What is the recommended management for couples presenting with unexplained infertility, based on the best available evidence in the literature? Summary answer The ESHRE Guideline on Unexplained infertility makes 19 recommendations on treatment of couples with unexplained infertility. What is known already? Unexplained infertility (UI) is diagnosed in the absence of any abnormalities of the female and/or male reproductive systems after “standard” investigations. The management of UI is traditionally empirical. The efficacy, safety, costs, and risks of treatment options have not been subjected to robust evaluation. Study design, size, duration The guideline was developed according to the structured methodology for the development of ESHRE guidelines. Following formulation of key questions by a group of experts, literature searches and assessments were undertaken. Papers written in English and published up until 24 October 2022 were included. Prior to publication, the guidelines were reviewed by independent international reviewers. Participants/materials, setting, methods Based on the available evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. A stakeholder review was organized after finalization of the draft. The final version was approved by the guideline group and the ESHRE Executive Committee. Main results and the role of chance This guideline aims to help clinicians provide the best care for couples with unexplained infertility. The first-line treatment for couples with unexplained infertility was deemed to be intra-uterine insemination (IUI) in combination with ovarian stimulation. This lecture will focus on the rationale behind this recommendation and the place of additional and alternative options for the treatment of unexplained infertility. The guideline has been in stakeholder review and is prepared for submission in 2023. Limitations, reasons for caution Most interventions in couples with unexplained infertility have not been subjected to robust evaluation. For a large proportion of these treatments, evidence was very limited and of very low quality. More evidence is required, and the results of future studies may require the current recommendations to be revised. Wider implications of the findings The guideline provides clinicians with clear advice on best practices in the care of couples with unexplained infertility, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in the field. Study funding/competing interest(s) The guideline was developed by ESHRE which funded the guideline meetings, the literature searches and dissemination. The guideline group members did not receive any financial incentives; all work was provided voluntarily.