The management of unexplained infertility

Special characteristics, reproductive, and clinical profile of women with unexplained infertility versus other causes of infertility: a comparative study

PURPOSE

To investigate whether women with unexplained infertility (UI) demonstrate different demographic and IVF characteristics compared to those with other causes of infertility.

METHODS

Data on 245 couples that underwent a total of 413 IVF/ICSI cycles were analyzed (UI 114 cycles, 73 women; anovulation (PCO/PCOS) 83 cycles, 51 women; tubal factor 85 cycles, 47 women; male factor 131 cycles, 74 women). Features of UI were compared versus other infertility groups, after adjustment for multiple comparisons. Generalized least squares (GLS) and random-effects logistic regression analysis were also performed.

RESULTS

Live birth rates, consisting of the primary outcome, were similar in all compared infertility groups. Compared to male infertility, UI was associated with woman's older age at cycle, lower body mass index (BMI), and higher follicle-stimulating hormone (FSH). Compared to tubal infertility, UI was linked to lower endometrial thickness at oocyte retrieval and lower BMI; compared to anovulatory infertility related to PCO/PCOS, UI was linked to woman's older age, more frequent smoking, and poorer ovarian reserve tests (FSH and antral follicle count). After adjustment for other types of infertility, woman's age, age at menarche, and FSH levels, anovulatory infertility presented with higher odds of clinical pregnancy compared to UI (adjusted OR = 2.13, 95% C: 1.01-4.52).

CONCLUSIONS

Infertile women with UI undergoing assisted reproduction demonstrate different demographic and clinical characteristics compared to those of other causes of infertility, albeit live birth rates are similar.

Aromatase inhibitors for female infertility: a systematic review of the literature

Ovulation induction remains a milestone in the treatment of women with anovulatory infertility. Clomiphene citrate (CC) is considered the first line treatment for induction of ovulation in women with polycystic ovary syndrome (PCOS), while it may be used for ovulation induction in unexplained infertility. Aromatase inhibitors (AI) have been introduced as a new treatment option that could challenge CC for ovulation induction. A systematic review of the literature was conducted in order to highlight the efficacy and safety of AI in female infertility. Current data from randomized and non-randomized trials suggest that AI may have a role in ovulation induction regimens in PCOS patients, as well as for ovarian stimulation, since they achieve comparable clinical pregnancy rates to CC. Furthermore, when combined with gonadotrophins, AI improve the ovarian response of poor responders and reduce the gonadotrophin dose required. However, the current review is based on small trials with a limited number of patients. If solid data from future large adequately powered randomized trials support current evidence regarding efficacy and safety, AI might offer a new treatment choice for infertile women.

Pregnancy rate following bromocriptine treatment in infertile women with galactorrhea

OBJECTIVE

Infertility is one of the most common causes of women refer to gynecology clinics. Galactorrhea is defined as one of the causes of infertility caused by luteal phase defect and anovulatory cycles. The study aim was to investigate the effect of bromocriptine on pregnancy rate in infertile women with galactorrhea with or without high prolactin level.

MATERIALS AND METHODS

In a prospective study, consecutive women with infertility and galactorrhea who referred to Afzalipour Hospital and a private clinic during 5 years from May 2001 to May 2006 were included. The study was conducted on 205 infertile women (18-39 years) with galactorrhea. They were treated with 2.5 mg bromocriptine BID for up to 6 months.

RESULTS

The mean duration of sterility was 43.1 +/- 37.1 months (range, 12-16). 76.1% of patients showed positive signs for pregnancy. The pregnancy rate was 81.7% in the patients with high prolactin level (>20 ng/dl) and 74.3% in the patients with normal prolactin level (P = 0.26). There was a significant difference between mean duration of treatment with bromocriptine in women with and without pregnancy, 103.71 and 193.03 days, respectively (P < 0.001).

CONCLUSION

Considering the efficacy of bromocriptine in the treatment of infertile women with galactorrhea, we suggest treatment with bromocriptine in these patients regardless of serum prolactin level.

Unexplained infertility: does it really exist? Does it matter?

Unexplained infertility (UI) refers to a diagnosis made in couples in whom standard investigations including semen analysis, tests of ovulation and tubal patency are normal. It has been suggested that the term UI is unsustainable, as conditions such as endometriosis, tubal infertility, premature ovarian ageing and immunological infertility tend to be misdiagnosed as UI. In this debate, we present the view that, although scientifically unsatisfying, the diagnosis of UI is sustainable from a clinical and practical perspective. Given our present treatment options, further investigations leading to a more 'accurate' diagnosis is unlikely to change our management in these cases. Scientific curiosity must take second place to a more pragmatic approach, which takes into account the clinical and financial costs of making a more 'accurate' diagnosis.

Follow-up of patients with unexplained infertility who previously underwent natural cycle in vitro fertilization

One hundred and seventeen couples with unexplained infertility who underwent natural cycle in vitro fertilization (NIVF) in the years 1991-1993 at the Sheffield Fertility Centre (SFC) formed the basis of this analysis, where they were followed in the following years. Seventy-six of the 117 patients who did not conceive came back for further treatment and they were offered either stimulated intrauterine insemination (SIUI) or stimulated in vitro fertilization (SIVF). If fertilization was confirmed at NIVF they then received SIUI for three treatment cycles and a change to SIVF treatment. If fertilization was not confirmed at NIVF they were then subjected to SIVF. Only 41 patients out of 117 (35%) did not come back for further treatment. The remaining 76 patients (65%) had 130 cycles of treatment, 58 cycles of SIUI and 72 cycles of SIVF. An implantation rate of 23.4% per cycle completed was achieved in the SIUI group. The rate of implantation for the SIVF group was 19.4% per cycle completed. We conclude that patients with unexplained infertility who failed fertilization at NIVF showed fertilization and implantation at SIVF and SIUI, and the implantation rate was similar in both groups.