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. 2020 Feb;113(2):305-322.
doi: 10.1016/j.fertnstert.2019.10.014.

Evidence-based treatments for couples with unexplained infertility: a guideline

Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org  1 ; Practice Committee of the American Society for Reproductive Medicine
Collaborators, Affiliations
Free article

Evidence-based treatments for couples with unexplained infertility: a guideline

Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org et al. Fertil Steril. 2020 Feb.
Free article

Abstract

Objective: To provide evidence-based recommendations to practicing physicians and others regarding the effectiveness and safety of therapies for unexplained infertility.

Methods: ASRM conducted a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1968 through 2019. The ASRM Practice Committee and a task force of experts used available evidence and informal consensus to develop evidence-based guideline recommendations.

Main outcome measure(s): Outcomes of interest included: live-birth rate, clinical pregnancy rate, implantation rate, fertilization rate, multiple pregnancy rate, dose of treatment, rate of ovarian hyperstimulation, abortion rate, and ectopic pregnancy rate.

Result(s): The literature search identified 88 relevant studies to inform the evidence base for this guideline.

Recommendation(s): Evidence-based recommendations were developed for the following treatments for couples with unexplained infertility: natural cycle with intrauterine insemination (IUI); clomiphene citrate with intercourse; aromatase inhibitors with intercourse; gonadotropins with intercourse; clomiphene citrate with IUI; aromatase inhibitors with IUI; combination of clomiphene citrate or letrozole and gonadotropins (low dose and conventional dose) with IUI; low-dose gonadotropins with IUI; conventional-dose gonadotropins with IUI; timing of IUI; and in vitro fertilization and treatment paradigms.

Conclusion(s): The treatment of unexplained infertility is by necessity empiric. For most couples, the best initial therapy is a course (typically 3 or 4 cycles) of ovarian stimulation with oral medications and intrauterine insemination (OS-IUI) followed by in vitro fertilization for those unsuccessful with OS-IUI treatments.

Keywords: Unexplained infertility; intrauterine insemination; in vitro fertilization; multiple pregnancy; ovarian stimulation.

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