Reviewing treatment options for patients with unexplained infertility

This article reviewed treatment options for patients with unexplained fertility (UEI). 

UEI is the inability to conceive without a known cause or reason. UEI can affect as many as 50% of couples experiencing infertility. In this case, common causes of infertility in both men and women have been ruled out.  As the exact cause of the problem is unknown, UEI is generally treated with the least costly treatment first. Understanding which treatment options are most beneficial for patients with UEI remains a challenge.

Expectant management involves ‘watchful waiting’ and small lifestyle changes that improve the chances of conceiving. It is the cheapest and least complicated treatment option. Expectant management is a good option for couples under age 35 who are experiencing UEI for a short time.

Laparoscopic surgery can be used to examine a woman’s organs and can be used to treat some conditions. Laparoscopy is only useful to treat patients with UEI with signs of disease in the fallopian tubes or pelvis. Laparoscopy may also be recommended for otherwise healthy young women with infertility for more than 3 years. 

Intrauterine insemination (IUI) involves placing fast-moving sperm into the woman's womb close to the time when the egg is released from the ovary (ovulation). IUI alone does not offer any benefit over expectant management. IUI can be combined with gonadotropin injections that help stimulate ovulation. This approach is effective but increases the chance of having twins or triplets. This makes the pregnancy higher-risk.

Ovarian stimulation causes the release of an egg. This can be done with the help of oral medications or gonadotropin injections. Combining these strategies may be more effective than either one alone. One study found that the birth rate associated with expectant management was 9% compared to 31% with IUI and oral medications.

In vitro fertilization (IVF) involves fertilizing an egg with a sperm in a laboratory dish before it is implanted into a woman's womb. In one study, patients with UEI who underwent IVF were 22 times more likely to have a successful birth compared to patients who had expected management. However, due to high cost and potential treatment complications, IVF should only be offered after three failed attempts with IUI and ovarian stimulation.

Intracytoplasmic sperm injection (ICSI) is a type of IVF that requires less sperm and is useful in cases of male infertility. The effectiveness of this treatment for patients with UEI remains under investigation.

This article reviewed treatment options for patients with unexplained fertility. The authors suggest that the best first-line treatments for UEI are expected management and IUI with ovarian stimulation. If these fail, IVF should be considered.

Talk to your doctor about which treatment options may be right for you.