Elsevier

Fertility and Sterility

Volume 105, Issue 6, June 2016, Pages 1566-1574.e1
Fertility and Sterility

Original article
Evidence-based approach to unexplained infertility: a systematic review

https://doi.org/10.1016/j.fertnstert.2016.02.001Get rights and content
Under an Elsevier user license
open archive

Objective

To summarize the available evidence for the efficacy of various treatments for unexplained infertility.

Design

Systematic review.

Setting

Not applicable.

Patient(s)

Patients aged 18–40 years with unexplained infertility.

Intervention(s)

Clomiphene citrate, letrozole, timed intercourse, IUI, gonadotropins, IVF, and IVF–intracytoplasmic sperm injection.

Main Outcome Measure(s)

Clinical pregnancy rate, ongoing pregnancy rate, and live birth rate.

Result(s)

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.

Conclusion(s)

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.

Key Words

Intrauterine insemination
in vitro fertilization
superovulation
unexplained infertility

Cited by (0)

D.D.G. has nothing to disclose. G.W.B. has nothing to disclose.