Treatment Of Unexplained Infertility Research Articles

Fertilization, pregnancy, and neonatal outcomes after IVF, rescue ICSI, and ICSI in unexplained infertility: A retrospective study

AbstractConventional intracytoplasmic sperm injection (ICSI) is not recommended for nonmale infertile patients to avoid fertilization failure (FF) in view of controversies regarding safety issues. Among the strategies that may help to promote the use of in vitro fertilization (IVF) for women with a high risk of FF, rescue ICSI (R‐ICSI) has attracted attention. This study aimed to evaluate the efficacy of short‐term insemination combined with early R‐ICSI in the treatment of unexplained infertility. A total of 952 controlled ovarian stimulation (COS) cycles for unexplained infertility were divided into short‐term IVF (short‐term insemination without R‐ICSI, n = 500), R‐ICSI (short‐term insemination with R‐ICSI, n = 141), and ICSI (conventional ICSI, n = 311) groups. Patients underwent consecutive transfer cycles until live birth, or until all embryos from the first COS cycle were used. Laboratory data and clinical outcomes from short‐term IVF, R‐ICSI, and ICSI groups were compared. Short‐term IVF and ICSI groups were superior to R‐ICSI group in polyspermy rate, available embryo rate, and top‐quality embryos rate. Short‐term IVF, R‐ICSI, and ICSI groups underwent 705 (500 fresh and 205 frozen‐thawed cycles), 190 (141 fresh and 49 frozen‐thawed cycles), and 445 (311 fresh and 134 frozen‐thawed cycles) transfer cycles, resulting in 294, 76, and 190 live birth cycles, respectively. Comparison of pregnancy outcomes among these three groups demonstrated similar clinical pregnancy rates and live birth rates in fresh and frozen‐thawed embryo transfer cycles. There was no significant difference in the cumulative live birth rate among these three groups. R‐ICSI group showed similar neonatal outcomes compared with short‐term IVF and ICSI groups, including the rates of low birth weight, fetal macrosomia, small for gestational age and large for gestational age. Short‐term insemination combined with early R‐ICSI achieved satisfactory pregnancy and neonatal outcomes, albeit with a high polyspermy rate, which was an effective alternative to avoid excessive use of ICSI in unexplained infertility.

Non-ART Treatment of Unexplained Infertility - Waiting, Tubal Flushing, Ovulation Assisting Agents?

Unexplained infertility is a common diagnosis affecting 20-25% of couples seeking infertility care. Till now, treatment of unexplained infertility remains empirical as no treatable cause of is identified. Interestingly the word “Unexplained Infertility” is used where physicians failed to come into conclusion to a diagnosis or failed to identify a detectable cause for couple’s infertility. There are many reasons why the diagnosis of infertility with detectable causes are difficult. It is not taken for granted that even in a well-documented diagnosis, that cause could be the sole reason of infertility. There is high observer to observer variations in the interpretation of diagnostic findings, sometimes diagnosis of endometriosis is missed and that couple is labelled as unexplained infertility. Unexplained infertility is inevitably diagnosed by exclusion after routine standard investigations. Unfortunately, a real standardization of the diagnostic workup is still missing. Management of unexplained infertility is basically empirical as far as the efficacies, safety, cost, and risks of each treatment option regards. The main problem of treating this couple is disagreement of physicians on the management plan. Failure in implementation of standard practice for treatment leads to over treatment in most of the cases. This practice is mainly accompanied with misdiagnosis of eligible cases of expected management. Existing guideline for Unexplained Infertility were released from Canadian Fertility and Andrology Society in 2019 and from ASRM in 2022. Based on these comprehensive guidelines, ESHRE special interest group (SIG) –Reproductive Endocrinology initiated the development of an ESHRE guideline focusing on the diagnosis and therapeutic management of couples with unexplained infertility. My presentation will be based on the non-ART management of unexplained infertility both expectant and active.

Role of Antioxidants in the Treatment of Unexplained Infertility

Role of Antioxidants in the Treatment of Unexplained Infertility

COMPARATIVE STUDY BETWEEN TIMED INTERCOURSE AND INTRAUTERINE INSEMINATION IN OVULATION STIMULATED CYCLES IN UNEXPLAINED INFERTILE COUPLES

Background and Objective: Every couple hopes to have children at least once in their lifetime. A painful reality is not being able to have one, even in today's generation, especially in developing countries, talking about infertility is frowned upon & therefore is a taboo, therefore it has become a signicant life stressor. The present study was done with an aim to study the efcacy & compare the result of TI & IUI in unexplained infertile couples with clomiphene citrate resulting in clinical pregnancy. In this Methodology: crossover observational study, total 60 patients were investigated with unexplained infertility were given COH, with clomiphene citrate followed by TI (group A) & IUI (group B), on not achieving pregnancy in either of the groups with three cycles each, these groups interchanged & received respective interventions, A positive UPT test was the comparing factor for assessing the effectiveness of the two interventions, i.e., TI& IUI. Results: Clinical pregnancy rates were seen both in COH/T1 & COH/IUI 7.4% & 31% respectively (4 in TI& 13 in IUI), out of which 76.45% were viable pregnancy & 23.5% were non viable (1 from TI& 3 from IUI). Being a diagnosis of e Interpretation & Conclusion: xclusion, treatment of unexplained infertility, has been shown by both TI& IUI in this study, however addition of IUI to ovulation induction gave better conception rates.

Sperm very long-chain polyunsaturated fatty acids: relation to semen parameters and live birth outcome in a multicenter trial

To determine whether the levels of sperm very long-chain polyunsaturated fatty acids (VLC-PUFAs) are correlated with sperm parameters and the outcome of live birth after conventional therapy for unexplained infertility. Cohort analysis of the Reproductive Medicine Network's Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation randomized controlled trial. Multicenter randomized controlled trial. Male partners from 185 couples with unexplained infertility who provided baseline semen samples for analysis. We determined the levels of VLC-PUFAs in total lipid isolated from sperm membranes using liquid chromatography-mass spectrometry/mass spectrometry analyses. Sperm concentration, motility, morphology, total motile count (TMC), and live birth after standard treatmentfor unexplained infertility. Total VLC-PUFA percentage was positively correlated with sperm concentration (Spearman's rank correlation (rs) 0.56, P<.0001), TMC (rs = 0.40, P<.0001), and morphology (rs = 0.26, P=.0005). After adjustment for male body mass index, age, and race, a one-standard-deviation increase in the percentage of total VLC-PUFA was associated with a 62% increase in the geometric mean (GM) of sperm concentration (GM Ratio: 1.62 [95% confidence intervals {CI}: 1.45, 1.82]) and a 43% increase in the geometric mean of TMC (GM Ratio: 1.43 [95% CI; 1.24, 1.63]). Although no evidence of association was observed for sperm motility, a positive relationship was also observed between the percentage of total VLC-PUFA and sperm morphology [adjusted incidence rate ratio (IRR) for one-standard-deviation increase in total VLC-PUFA: 1.18 (95% CI; 1.02, 1.36)]. After adjustment for female age and treatment group, the probability of a live birth outcome was 72% more likely among those in the third tertile of hydroxylated VLC-PUFA percentage than in the first tertile (RR 1.72 [95% CI; 1.01, 2.94]). The positive correlation between sperm VLC-PUFAs percentage and sperm parameters, as well as the significant association between hydroxylated VLC-PUFA percentage and the outcome of live birth, strongly suggest that this class of fatty liquid chromatography-mass spectrometry/mass spectrometry acids is essential for normal sperm structure and function.

Should intrauterine inseminations still be proposed in cases of unexplained infertility? Retrospective study and literature review.

Unexplained infertility is defined by the absence of identifiable causes of infertility. The results of randomized studies and meta-analysis regarding the treatment of unexplained infertility are discordant due to methodological problems. The aim of this study is to compare the clinical pregnancy rate per cycle (CPR/c) in IUI and IVF/ICSI in cases of unexplained infertility, according to the woman's age group and to identify the factors which predict success. We performed a retrospective study in two ART centers, comparing overall clinical pregnancy, ongoing pregnancy and live birth rates in IVF/ICSI and IUI. We also compared pregnancy and birth rates according to different female age groups. 855 IVF/ICSI and 804 IUI cycles were compared. We found a significant difference (p < 0.001) in the pregnancy and live birth rates per cycle between IUI and IVF/ICSI, overall and in the different female age groups, except in women aged 40 and over. The greatest chances of pregnancy with IUI are found in women with secondary unexplained infertility, during the first two cycles and with a bi-follicular response to stimulation. In IVF/ICSI, pregnancy rates are higher in women with secondary unexplained infertility, in the first two cycles, in IVF and in women receiving a transfer of two embryos regardless of the embryonic stage. We recommend IVF/ICSI treatment rather than IUI for unexplained infertility (OR CPR/c 4.20 with 95% CI [3.72-4.68]). This is in accordance with NICE, which advises the use of IVF after 2years.

ICSI Does Not Improve Live Birth Rates but Yields Higher Cancellation Rates Than Conventional IVF in Unexplained Infertility.

Objectives: Unexplained infertility has been one of the indications for utilization of intracytoplasmic sperm injection (ICSI). However, whether ICSI should be preferred to IVF for patients with unexplained infertility remains an open question. This study aims to determine if ICSI improves the clinical outcomes over conventional in vitro fertilization (IVF) in couples with unexplained infertility.Methods: This was a retrospective cohort study of 549 IVF and 241 ICSI cycles for patients with unexplained infertility at a fertility center of a university hospital from January 2016 and December 2018. The live birth rate and clinical pregnancy rate were compared between the two groups. Other outcome measures included the implantation rate, miscarriage rate, and fertilization rate.Results: The live birth rate was 35.2% (172/488) in the IVF group and 33.3% (65/195) in ICSI group, P = 0.635. The two groups also had similar clinical pregnancy rates, implantation rates, and miscarriage rates. The fertilization rate of IVF group was significantly higher than that of ICSI group (53.8 vs. 45.7%, P = 0.000, respectively). Sixty-one and 46 patients did not transfer fresh embryos in IVF and ICSI cycles, respectively. Patients with IVF cycles had lower cancellation rates than those with ICSI (11.1 vs. 19.1%, P = 0.003, respectively).Conclusion: ICSI does not improve live birth rates but yields higher cancellation rates than conventional IVF in the treatment of unexplained infertility.

Endometrial thickness after ovarian stimulation with gonadotropin, clomiphene, or letrozole for unexplained infertility, and association with treatment outcomes

To study the association of endometrial thickness (EMT) with live birth rates (LBR) in ovarian stimulation with intrauterine insemination (OS-IUI) treatments for unexplained infertility. Prospective cohort analysis of the Reproductive Medicine Network's Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) randomized controlled trial. Multicenter randomized controlled trial. A total of 868 couples with unexplained infertility (n=2,459 cycles). OS-IUI treatment cycles (n = 2,459) as part of the AMIGOS clinical trial. Live birth rates; unadjusted and adjusted risk ratios (RR) for live birth by EMT category, calculated using generalized estimating equations. The overall mean EMT on day of human chorionic gonadotropin administration in cycles with a live birth was significantly greater than in those without. Compared to the referent EMT group of 9 to 12 mm, the unadjusted RR for live birth for the EMT groups of ≤5 and 6-8 were 0.48 and 0.92, respectively. The test for trend indicated evidence of decreasing LBR with decreasing EMT. After adjustment for ovarian stimulation medication, a linear trend was no longer supported. Stratified analyses revealed no differences in associations by treatment group. In OS-IUI for unexplained infertility, higher LBR are observed with increasing EMT; however, EMT is not significantly associated with LBR when adjusted for OS treatment type. Appreciable LBR are seen at all EMT, even those of ≤5 mm, suggesting that OS-IUI cycles should not be canceled for thin endometrium. NCT01044862.

Clinical study of hysteroscopy combined with laparoscopy in the diagnosis and treatment of unexplained infertility

Objective: To explore the importance of the diagnosis and treatment value of laparoscopy and hysteroscopy in patients with unexplained infertility. Methods: A total of 519 cases diagnosed as unexplained infertility, received laparoscopy and hysteroscopy in Peking Union Medical College Hospital from May 2012 to December 2015. The causes of infertility were evaluated, and the subjects were followed up to observe the nature pregnancy rate. Results: Among 519 unexplained infertility patients, pelvic abnormalities had been explored in 466 (89.8%, 466/519) cases. Pelvic endometriosis combined with adhesions, pelvic adhesion alone, uterine leiomyoma and uterine cavity polyp were 72.4% (376/519), 12.3% (64/519), 3.7% (19/519) and 1.3% (7/519) respectively. The total natural pregnancy rate within the 3 years of follow up was 53.9% (208/386), and the natural pregnancy rate was 29.8% (31/104) in patients aged 35 years and over. Conclusions: The patients with clinical diagnosis of unexplained infertility should be examined by hysteroscopy and laparoscopy. Under the examination, the causes of infertility could be found more intuitively, and targeted treatment could be carried out to improve the pregnancy rate. The natural pregnancy rate of the elderly patients decrease obviously after operation, and the time of natural trying pregnancy should not be too long.

Does endometrial scratching increase the rate of spontaneous conception in couples with unexplained infertility and a good prognosis (Hunault >\u200930%)? Study protocol of the SCRaTCH-OFO trial: a randomized controlled trial

BackgroundIn the Netherlands, couples with unexplained infertility and a good prognosis to conceive spontaneously (i.e. Hunault > 30%) are advised to perform timed intercourse for at least another 6 months. If couples fail to conceive within this period, they will usually start assisted reproductive technology (ART). However, treatment of unexplained infertility by ART is empirical and can involve significant burdens. Intentional endometrial injury, also called ‘endometrial scratching’, has been proposed to positively affect the chance of embryo implantation in patients undergoing in vitro fertilization (IVF). It might also be beneficial for couples with unexplained infertility as defective endometrial receptivity may play a role in these women. The primary aim of this study is to determine whether endometrial scratching increases live birth rates in women with unexplained infertility.MethodA multicentre randomized controlled trial will be conducted in Dutch academic and non-academic hospitals starting from November 2017. A total of 792 women with unexplained infertility and a good prognosis for spontaneous conception < 12 months (Hunault > 30%) will be included, of whom half will undergo endometrial scratching in the luteal phase of the natural cycle. The women in the control group will not undergo endometrial scratching. According to Dutch guidelines, both groups will subsequently perform timed intercourse for at least 6 months. The primary endpoint is cumulative live birth rate. Secondary endpoints are clinical and ongoing pregnancy rate; miscarriage rate; biochemical pregnancy loss; multiple pregnancy rate; time to pregnancy; progression to intrauterine insemination (IUI) or IVF; pregnancy complications; complications of endometrial scratching; costs and endometrial tissue parameters associated with reproductive success or failure. The follow-up duration is 12 months.DiscussionSeveral small studies show a possible beneficial effect of endometrial scratching in women with unexplained infertility trying to conceive naturally or through IUI. However, the quality of this evidence is very low, making it unclear whether these women will truly benefit from this procedure. The SCRaTCH-OFO trial aims to investigate the effect of endometrial scratching on live birth rate in women with unexplained infertility and a good prognosis for spontaneous conception < 12 months.Trial registrationNTR6687, registered August 31st, 2017.Protocol versionVersion 2.6, November 14th, 2018.

Application of Misoprostol as a Treatment of Unexplained Infertility in Mares

Misoprostol is a synthetic Prostaglandin E1 (PGE1), one of the prostaglandin E (PGE) family hormones, which promotes oviduct dilatation and motility, reestablishing fertility rates in mares suspected of uterine tubal block. It is known that topical application of PGE on the surface of the uterine tubes via laparoscopic procedure improved embryo recovery and pregnancy rates in barren mares with unexplained infertility. The aim of this study was to observe if the treatment using Misoprostol could be performed via intrauterine application. Mares used in this study had been barren for at least 2 years before the treatment, without embryo or pregnancy, with a history of unexplained infertility. Thus, 22 subfertile mares, aged 5 to 26 years, were treated by a deep uterine horn application, using one Cytotec tablet (200 mcg of Misoprostol, Pfizer, USA) diluted in 3 mL of sterile water, in each horn, aiming the application as close as possible to the papilla of uterine tubes. These procedures were performed during the diestrus period, and mares were bred in the next cycle. Embryos were produced, or a pregnancy was obtained from 15 of the 22 mares within the first two cycles following Cytotec treatment. Ten of 15 mares bred as embryo donors produced embryos (0.4 embryos/cycle) in the three subsequent cycles, and six of seven mares bred to carry became pregnant after treatment. In conclusion, Misoprostol therapy can be performed via intrauterine as a potential treatment for mares with unexplained infertility, making easier and safer the treatment of these mares.

A Study of Endometrial Perfusion in Unexplained Infertility

Background: Infertility in itself represents a wide spectrum of disorders explaining the inability to conceive. Series of investigations are required to depict the potential cause of infertility, yet there exist a small percentage (10 -25%) of couples in which no obvious cause is delineated. these groups of patients are classified as ‘unexplained infertility. The endometrium has dynamic features: cyclical growth, desquamation and regeneration. Its main function is to provide the possibility of the time-limited support of implantation of the embryo for further development. Most part of the menstrual cycle, the endometrium is resistant to the embryo but acquires special receptive properties in a limited space and time interval of the luteal phase, known as the ‘‘implantation window’’. Aim: The aim of this study was to evaluate the uterine perfusion, particularly the endometrial blood flow in women with unexplained infertility. Methodology: The patients recruited from women presenting to the outpatient clinic at Ain Shams University Maternity Hospital seeking fertility compared to other fertile group coming to hospital with non specific gynecological problems or for routine checkup at the same period. The study conducted on two groups of women: Group1(study group) 40 women with unexplained infertility, Group 2 (control group) 20 fertile women who had normal physical and pelvic examination, regular menstrual cycles, didn't have intrauterine device or oral contraceptive, and gave a birth year ago. Results: As regard the mean, the resistance index in the study group was 0.69 ranged from 0.39 to 0.96, while the resistance index in the control group was 0.61 ranged from 0.58 to 0. 73 and the difference between both groups was statistically significant pulsatility index in the study group was 1.3 ranged from 0.51 to 1.99 while the pulsatility index in the control group was 1.16 ranged from 0.88 to 1.7 and this difference between both groups was statistically significant. From the results of our study we could say that uterine perfusion, particularly the endometrial blood flow in women with unexplained infertility different from that in fertile women. Recommendation: We recommend further study on large numbers of women and the possible role of perfusion enhancer's drugs in improving utero-ovarian circulation as a treatment of unexplained infertility.

A Study of Endometrial Perfusion in Unexplained Infertility

Background: Infertility in itself represents a wide spectrum of disorders explaining the inability to conceive. Series of investigations are required to depict the potential cause of infertility, yet there exist a small percentage (10 -25%) of couples in which no obvious cause is delineated. these groups of patients are classified as ‘unexplained infertility. The endometrium has dynamic features: cyclical growth, desquamation and regeneration. Its main function is to provide the possibility of the time-limited support of implantation of the embryo for further development. Most part of the menstrual cycle, the endometrium is resistant to the embryo but acquires special receptive properties in a limited space and time interval of the luteal phase, known as the ‘‘implantation window’’. Aim: The aim of this study was to evaluate the uterine perfusion, particularly the endometrial blood flow in women with unexplained infertility. Methodology: The patients recruited from women presenting to the outpatient clinic at Ain Shams University Maternity Hospital seeking fertility compared to other fertile group coming to hospital with non specific gynecological problems or for routine checkup at the same period. The study conducted on two groups of women: Group1(study group) 40 women with unexplained infertility, Group 2 (control group) 20 fertile women who had normal physical and pelvic examination, regular menstrual cycles, didn't have intrauterine device or oral contraceptive, and gave a birth year ago. Results: As regard the mean, the resistance index in the study group was 0.69 ranged from 0.39 to 0.96, while the resistance index in the control group was 0.61 ranged from 0.58 to 0. 73 and the difference between both groups was statistically significant pulsatility index in the study group was 1.3 ranged from 0.51 to 1.99 while the pulsatility index in the control group was 1.16 ranged from 0.88 to 1.7 and this difference between both groups was statistically significant. From the results of our study we could say that uterine perfusion, particularly the endometrial blood flow in women with unexplained infertility different from that in fertile women. Recommendation: We recommend further study on large numbers of women and the possible role of perfusion enhancer's drugs in improving utero-ovarian circulation as a treatment of unexplained infertility.

An ICSI rate of 90% minimizes complete failed fertilization and provides satisfactory implantation rates without elevating fetal abnormalities

IVF cycles utilizing the ICSI technique for fertilization have been rising over the 25 years since its introduction, with indications now extending beyond male factor infertility. We have performed ICSI for 87% of cases compared with the ANZARD average of 67%. This retrospective study reports on the outcomes of 1547 autologous ART treatments undertaken over a recent 3-year period. Based on various indications, cases were managed within 3 groupings - IVF Only, ICSI Only or IVF-ICSI Split insemination where oocytes were randomly allocated. Overall 567 pregnancies arose from mostly single embryo transfer procedures up to December 2016, with 402 live births, comprising 415 infants and a low fetal abnormality rate (1.9%) was recorded. When the data was adjusted for confounders such as maternal age, measures of ovarian reserve and sperm quality, it appeared that IVF-generated and ICSI-generated embryos had a similar chance of both pregnancy and live birth. In the IVF-ICSI Split model, significantly more ICSI-generated embryos were utilised (2.5 vs 1.8; p < 0.003) with productivity rates of 67.8% for pregnancy and 43.4% for livebirths per OPU for this group. We conclude that ART clinics should apply the insemination method which will maximize embryo numbers and the first treatment for unexplained infertility should be undertaken within the IVF-ICSI Split model. Whilst ICSI-generated pregnancies are reported to have a higher rate of fetal abnormalities, our data is consistent with the view that the finding is not due to the ICSI technique per se.

Midluteal Progesterone: A Marker of Treatment Outcomes in Couples With Unexplained Infertility.

Adequate luteal phase progesterone exposure is necessary to induce endometrial changes required for a successful pregnancy outcome. The relationship between low midluteal progesterone concentration and the outcome of live birth in ovarian stimulation with intrauterine insemination (OS-IUI) treatments is not defined. To determine the level of midluteal progesterone portending a low chance of live birth after OS-IUI in couples with unexplained infertility. Secondary analyses of data from a prospective, randomized, multicenter clinical trial that determined pregnancy outcomes following OS-IUI with clomiphene citrate, letrozole, or gonadotropins for couples with unexplained infertility. Couples (n = 900) underwent 2376 OS-IUI cycles during the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation clinical trial. Live birth as it relates to midluteal progesterone level and thresholds below which no live births occur by treatment group. Thresholds for non-live birth cycles were similar for clomiphene (14.4 ng/mL) and letrozole (13.1 ng/mL) yet were lower for gonadotropin (4.3 ng/mL) treatments. A midluteal progesterone level >10th percentile specific for each treatment group independently was associated with greater odds for a live birth in all OS-IUI cycles (adjusted OR: 2.17; 95% CI: 1.05, 4.48). During OS-IUI, a low midluteal progesterone level was associated with a low probability of live birth. Thresholds differed by medication, with the lowest threshold for gonadotropin. Several pathophysiologic mechanisms may account for low progesterone levels. Refinement of the predictive range associated with particular ovarian stimulation medications during treatment of unexplained infertility may improve accuracy.

Unexplained Infertility: A Biomarker for Decreased Ovarian Reserve in Young Women [15B

INTRODUCTION: After 12 months of regular intercourse and appropriate evaluation to assure normal ovulation and sperm quality with patent fallopian tubes, no etiology is identified in up to 1/3 of couples. The treatment for Unexplained Infertility (UI), especially for younger couples (&lt;35 years), is largely empiric. Recent IVF data suggests UI in younger women is associated with lower embryo quality and may be related to prematurely Decreased Ovarian Reserve (DOR). In the present study DOR, as measured by Anti-Mullerian Hormone (AMH), was assessed as part of the initial evaluation of young nulligravid couples with &gt;12 months attempting pregnancy. METHODS: Three hundred and forty-three nulligravid couples (18-34 yrs) were evaluated with assessment of tubal patency, ovulatory and anatomic status by mid-cycle TVUS, comprehensive semen analysis, and assessment of DOR with serum AMH. RESULTS: An infertility diagnosis was confirmed in 142/343 (41%): anovulation 30%; anatomic abnormality 9%; male factor 6%. UI, the default diagnosis, was made in 201/343 (59%). Of the 201 women with UI, AMH was &lt;95% of age appropriate values in 118 (59%). Most surprisingly, 53/201 (26%) UI women &lt;35 had an AMH value of &lt;1.5. CONCLUSION: The results of this study suggest 1) In all women with UI, independent of age, assessment of ovarian reserve should be included in the initial evaluation of fertility status; 2) In young women with premature DOR, consultation with a fertility specialist is warranted to discuss appropriate treatment modalities; 3) Beyond fertility concerns, DOR may herald a premature perimenopausal transition with the associated cardiovascular health implications.

Evidence-based approach to unexplained infertility: a systematic review

To summarize the available evidence for the efficacy of various treatments for unexplained infertility. Systematic review. Not applicable. Patients aged 18-40years with unexplained infertility. Clomiphene citrate, letrozole, timed intercourse, IUI, gonadotropins, IVF, and IVF-intracytoplasmic sperm injection. Clinical pregnancy rate, ongoing pregnancy rate, and live birth rate. Thirteen studies with a total of 3,081 patients were identified by systematic search and met inclusion criteria. The available literature demonstrates that expectant management may be comparable to treatment with clomiphene and timed intercourse or IUI. Clomiphene may be more effective than letrozole, and treatment with gonadotropins seems more effective, albeit with significantly higher risk of multiple gestations than either oral agent. On the basis of current data, IVF, with or without intracytoplasmic sperm injection, is no more effective than gonadotropins with IUI for unexplained infertility. Adequately powered, randomized controlled trials that compare all of the available treatments for unexplained infertility are needed. Until such data are available, clinicians should individualize the management of unexplained infertility with appropriate counseling regarding the empiric nature of current treatment options including IVF.

In Women Under 35 with Unexplained Infertility, IUI Cycle Outcomes Using 50 mg of Clomiphene Citrate are Similar to Those Using 100 mg

Clomiphene Citrate (CC) is commonly used for ovulation induction in treatment of unexplained infertility. Ultrasound monitoring is often utilized to determine optimal timing for intrauterine insemination (IUI). Though the lead follicle size, and number of dominant follicles is often used to manage CC dosing, there is little data available with regards to ultrasound findings and subsequent pregnancy outcomes.

Treatment of Unexplained Infertility by Acupuncture in Natural and Control Ovarian Hyperstimulation Cycles: A Prospective Analysis

Acupuncture is an important method of treatment in Chinese medicine. The objective of this study was to evaluate the efficacy of acupuncture as an adjuvant treatment for unexplained infertility. Here we conducted a prospective study, with data consisting of acupuncture group (38 cases) and control group (42 cases). Infertility evaluation workup consisted of semen analysis, ovulation assessment, hysterosalpingogram (HSG) and blood analysis. The patients in acupuncture group received 3 acupuncture sessions, and each at seven acupuncture points (EX-CA1, CV4, CV6, SP10, ST36, SP6, and KI3). The session started 12 days before menstruation and continued for 10 days. The patients in control group did not receive acupuncture. All patients tried 1 - 3 natural cycles 3 months after HSG test, if not pregnant, underwent 1 - 3 cycles of control ovarian hyperstimulation (COH) and timed intercourse. Pregnancy was evaluated by measurement of blood β human chorionic gonadotrophin (β-hCG) and subsequent trans-vaginal ultrasound. No significant difference of clinical pregnancy rate was found between the acupuncture group and the control group, however, numbers of COH cycles were significantly less and more pregnancies occurred in natural cycle in the acupuncture group. We concluded that acupuncture can be used as an adjuvant treatment for unexplained infertility. Although acupuncture did not increase the cumulative pregnancy rate, it decreased the number of COH cycles and more patients got pregnant in natural cycles after receiving acupuncture.

A panoramic view to relationships between reproductive failure and immunological factors

To examine the possible roles of various immunological factors in recurrent miscarriage and unexplained infertility. The synthesis and review of the relevant current literature in English language. Substantial evidence suggests that antiphospholipid antibodies, lupus anticoagulant, antisperm antibodies, antithyroid antibodies, anti-endometrial antibodies, antiovarian antibodies, anti-C trachomatis antibodies, cytokines, and immunological events in endometriosis and premature ovarian failure due to immunologic factors may contribute to reproductive failure including unexplained infertility and/or non-chromosomal recurrent miscarriage. Elimination or suppression of the immunological factors related with reproductive failure might occupy an important place in the treatment of unexplained infertility and non-chromosomal recurrent miscarriage.