Unexplained Infertility Group Research Articles

A comparison of intrauterine insemination, intraperitoneal insemination, and natural intercourse in superovulated women

In a prospective comparison of IP, IUI, and natural intercourse following superovulation in couples diagnosed as having unexplained infertility, semen factors, or sperm antibodies, pregnancy rates were found to be significantly higher after IP. Pregnancy rates were also higher in the unexplained infertility group when compared with those with semen factors. It was concluded that IP in combination with superovulation offered a simple, inexpensive, safe alternative to GIFT.

Intrauterine insemination and comparison of two methods of sperm preparation

In a study of intrauterine inseminations (IUI) after clomiphene stimulation, a randomized comparison was made between a new method of sperm preparation, self migration in sodium hyaluronate (SH), and a traditional method, centrifugation and swim up (CS). After two IUI cycles with either SH or CS, the sperm preparation method was swapped and the patients received another two IUI cycles. Interjacent cycles of natural intercourse after clomiphene treatment served as the control. The SH method resulted in a significantly higher percentage recovery of progressive motile spermatozoa than the CS method, 17.7% versus 8.6% (P less than 0.01). The sperm samples were prepared by SH in 68 cycles and by CS in 57 cycles, resulting in six and five pregnancies, respectively. Pregnancies were obtained in 11 of 125 IUI cycles (8.8%) and in 3 of 124 control cycles (2.4%) (P less than 0.05). The pregnancy rate following IUI was highest in the patients with cervical factor (35%) and asthenozoospermia (23%), while none became pregnant in the group with oligozoospermia. In the unexplained infertility group, no difference between the pregnancy rates in IUI cycles and control cycles was seen. SH is a simple and rapid method of sperm preparation and it appears to give a high recovery of motile spermatozoa and a number of pregnancies which is comparable to that of CS. Treatment with IUI in cycles with a simple stimulation protocol seems to be valuable in cases involving either a cervical factor or asthenozoospermia.

Reproductive failure because of autoantibodies: Unexplained infertility and pregnancy wastage

Abnormal polyclonal B cell activation has been demonstrated in patients with endometriosis. To determine whether the noted B cell abnormalities were primarily a feature of the disease endometriosis or its manifestations of infertility and pregnancy wastage, we investigated antibody profiles in 26 female patients with unexplained infertility (group A) and 24 patients with unexplained pregnancy wastage (group B) but without documented endometriosis. Group A and B patients exhibited an unusual incidence of gammopathies (10 of 26 patients in group A and 11 of 24 in group B), with a majority representing immunoglobulin M gammopathies. Mean immunoglobulin M values were significantly elevated in both groups (p less than 0.03 and p less than 0.05, respectively, Student t test), whereas immunoglobulin G was significantly increased only among group B patients (p less than 0.05, Student t test). Lupus anticoagulant by tissue thromboblastin inhibition test was abnormally elevated in 2 of 26 group A and 2 of 24 group B patients. Activated partial thromboplastin time values were abnormal in only 3 of 26 group A and 2 of 24 group B women. Immunoglobulin G, immunoglobulin M, and immunoglobulin A autoantibodies to two phospholipid antigens, five histones, and four polynucleotide autoantibodies were detected in 23 of 26 (88%) group A patients and 17 of 24 (70.8%) group B patients. We conclude that some patients with unexplained infertility and pregnancy wastage suffer from polyclonal B cell activation. It is therefore tempting to speculate that autoantibody abnormalities may be causally related to infertility and pregnancy loss.

The performance of primary and secondary unexplained infertility in an in vitro fertilization-embryo transfer program

The term "unexplained infertility" is applied to a couple in whom after an elaborate workup no apparent reason for infertility is found. Between August 1985 and May 1987, 435 patients underwent 720 treatment cycles in an in vitro fertilization-embryo transfer (IVF-ET) unit. Eighty-three of the patients had unexplained infertility as their indication for IVF-ET. Fifty-two (group A) had primary unexplained infertility and 31 (group B) had secondary unexplained infertility. Group A underwent 87 and group B underwent 50 treatment cycles. Forty-six ET were performed in group A and 34 in group B. Clinical pregnancies were achieved in 20 patients of group A (11.5% per treatment cycle) and 13 of group B (26.0%), for a combined rate of 16.8% per cycle. Patients with tubal infertility treated in the program had a pregnancy rate of 18.8% per treatment cycle. The performance of the secondary unexplained infertility group is significantly better than that of the primary unexplained infertility group. However, the overall results with patients with unexplained infertility are similar to those patients treated for tubal infertility.

Bromocriptine therapy in normoprolactinemic women with unexplained infertility and galactorrhea

Forty-three women with unexplained infertility and 16 women who ovulated with clomiphene citrate therapy, yet failed to conceive, were evaluated because of the presence of expressible galactorrhea and normal random prolactin levels. The overall mean duration of infertility for these women was 5.68 ± 0.33 years (mean ± standard error) and their mean age was 30.20 ± 0.46 years. Fifty-two of these women had primary infertility. Three treatment protocols were evaluated. Twenty-five women with unexplained infertility (Group A) received low-dose bromocriptine (125 to 2.5 mg) at bedtime for the first 18 days of the cycle; 18 women with unexplained infertility (group B) received 100 mg of pyridoxine continuously; and 16 women receiving clomiphene citrate (group C) also received bromocriptine in a manner similar to that for group A. All subjects were followed for six treatment cycles or until pregnancy occurred. The estimated cumulative pregnancy rate after six treatment cycles was 65% for groups A and C, which is significantly higher than the 22% rate for group B (Lee-Desu statistic = 4.66, P = 0.03). Women treated with bromocriptine were 2.3 times more likely to conceive than women treated with pyridoxine. Furthermore, those infertile galactorrheic women whose random prolactin level was ≥ 15 ng/ml were most likely to conceive. Expressible galactorrhea in women with unexplained infertility and high normal prolactin concentrations may serve as a clinical sign indicating those women who may benefit from low-dose bromocriptine treatment administered at bedtime.

Pregnancy rates after laparoscopy for infertility.

To obtain prognostic data on the likelihood of pregnancy in infertile women with no observable abnormalities at diagnostic laparoscopy, the occurrence of pregnancy was studied in a series of 229 patients. The cumulative conception rate during a follow-up period of at most 5 yr was 50%. The probability of pregnancy proved to decline with age and duration of infertility. The cumulative conception rate during the first year after laparoscopy was approx. 30%, and there was no significant difference between the patients that were treated with respect to other sub-optimal fertility factors (subfertile group) and the patients in whom no rational treatment could be instituted (unexplained infertility group). Implications of these findings with respect to the treatment of long-term infertility are discussed. Knowledge of pregnancy rates after infertility laparoscopy seems important for the evaluation of results of therapy in unexplained infertility.

Increased Pregnancy Rate with Oil-Soluble Hysterosalpingography Dye

The diagnostic value of hysterosalpingography remains unquestioned. Previous studies have suggested that patients who underwent hysterosalpingography with an oil-soluble contrast medium (OSCM) rather than a water-soluble contrast medium (WSCM) had higher subsequent fertility rates. This study evaluated subsequent fertility rates in 339 patients who underwent hysterosalpingography in which OSCM or WSCM was used. All forms of infertility were included and over-all, pregnancy occurred in the WSCM group in 21 of 162 patients (13%), in the OSCM group in 51 of 177 patients (29%); these rates were significantly different (P < 0.001), with the unexplained infertility group and the male factor infertility group showing the most significant difference. Adverse effects of OSCM hysterosalpingography were not corroborated. For this reason it is suggested that initially the patient undergo hysterosalpingography with WSCM. Once patency has been established, 3 ml of OSCM should be injected as a therapeutic modality to increase subsequent fertility.