The better prognosis in secondary infertility is associated with a higher proportion of ovulation disorders

Unexplained infertility: a review of diagnosis, prognosis, treatment efficacy and management

The dilemma of unexplained infertility posed by Southam in 1960 remains today: despite advances in the diagnostic assessment of infertility, many couples still have no explanation for their infertility. Even the most sophisticated evaluation of semen, ovulation and genital tract competence cannot reveal all of the possible defects in the complex process leading to conception. Because it arises from these shortcomings in our knowledge of fertilization and from our inability to utilize all of the current knowledge, unexplained infertility is a challenge for both biological and clinical research. This paper attempts to summarize some clinical issues in the management of unexplained infertility: the prevalence of the disorder, problems in the definition and possible explanations for the existence of this diagnostic category. It reviews outcome-based clinical publications as a guide to decision-making on what diagnostic tests to use, provides a summary of the untreated prognosis and evaluates study results that may serve as a basis for treatment decisions in this puzzling diagnostic category of infertility.

Score prognosis for the infertile couple based on historical factors and sperm analysis

OBJECTIVE

To identify variables, obtained from historical factors and sperm analysis, associated with greater chances of pregnancy in infertile couples.

METHODS

The study was carried out in Córdoba, Argentina. The characteristics of 247 couples consulting for infertility who achieved pregnancy within 3 years of their first visit were compared with those of 312 couples who did not become pregnant. We evaluated the relationship between the age of the woman and her partner, the type and duration of infertility, length of the last three menstrual cycles, history of pelvic surgery in the woman, and testicular volume, sperm density, motility and morphology in her partner, and the achievement of pregnancy. For the analysis, logistic regression was used.

RESULTS

Six variables had a predictive value: sperm morphology, the woman's age, type and duration of infertility, her history of pelvic surgery, and duration of menstrual cycles.

CONCLUSIONS

The best prognosis for future fertility in infertile couples is correlated with a higher percentage of normal sperm morphology, younger woman's age, secondary infertility, fewer years of infertility, negative history of pelvic surgery, and abnormal menstrual cycles.

Age of the female partner is a prognostic factor in prolonged unexplained infertility: a multicenter study

Among 2,106 couples registered in 12 Canadian infertility clinics, 470 (22.3%) were classed as unexplained infertility after a uniform evaluation of the male ejaculate, ovulation, and tubal patency. The unexplained group included more older female partners; 44% were over 30 years of age at registration in the participating clinics, compared with 36% in other infertility diagnostic groups. The mean duration of infertility was 40.1 months, and the cumulative pregnancy rate was 36.6 +/- 2.9% at 2 years after registration. When the variables were examined with the use of proportional hazards analysis, each additional month of duration of infertility reduced the expected prognosis by 2%, and a history of pregnancy in the partnership improved the prognosis by 80%. Among couples with 3 years or more duration of infertility (cumulative pregnancy rate, 27.5 +/- 3.9%), an additional year in the age of the female partner when conception was first attempted (mean, 26.8 years) reduces the prognosis by 9%.