Unexplained infertility: an update and review of practice

Abstract

Of the couples unable to conceive without any identifiable cause, 30% are defined as having unexplained infertility. Management depends on duration of infertility and age of female partner. This review describes and comments on the definition and evidence for the management of unexplained infertility. A literature search was conducted in EMBASE, Medline, Ovid and Cochrane Database of Systematic reviews using the terms 'infertility', 'unexplained infertility', 'idiopathic infertility', 'definition of infertility', 'treatment options', 'intrauterine insemination', 'ovulation induction', 'Fallopian tube sperm', 'GIFT' and 'IVF'. There is no uniform definition for unexplained infertility. This varies in the literature depending on the duration of infertility and the age of the female partner. The treatment of unexplained infertility is empirical and many different regimens have been used. Among these are expectant management, ovulation stimulation with clomiphene citrate, gonadotrophins and aromatase inhibitors, Fallopian tube sperm perfusion, tubal flushing, intrauterine insemination, gamete intra-Fallopian transfer and IVF. The standard protocol is to progress from low-technology to high-technology treatment options. On the best available evidence, an algorithm for management is suggested. There is a definite need for multicentre randomized controlled trials to identify the best treatment option in unexplained infertility using a standard definition.

Levels of prolactin, progesterone, estradiol, luteinizing hormone and follicle stimulating hormone in infertile women in Calabar, Nigeria

“…1 Infertility occurs in one out of five couple of reproductive age and in ten to twenty per cent of these cases, there seems to be no definitive cause, therefore these are classified as unexplained infertility. 2,3 Studies by Boivin et al found that the prevalence of infertility was nine per cent, for less developed countries. 4 In Britain male factor infection accounts for 25% of infertile couple while 25% remain unexplained and 50% are female cause with 25% being due to anovulation and 25% tubal problem/others.…”

Lipomesosalpinx: a rare possible missed tubal factor of infertility

“…To date, there is no uniform definition for UI [6]. With the marvelous advancement in illumination and magnification, endoscopy would add a lot for the diagnostic work-up for cases with UI.…”

“…It is idiopathic in the sense that its cause remains unknown even after an infertility work-up, usually including semen analysis in the man and assessment of ovulation and fallopian tubes in the woman [6]. In Assiut, we believe that diagnostic laparoscopy is an integral step of the diagnostic work-up of any infertile couple before saying the term "unexplained".…”

Endoscopic Explanation of Unexplained Infertility

“…The development of better methods of diagnosis due to better understanding of physiology of ovulation, advent of ultrasound, endoscopy and other modern equipments have changed the whole approach to this problem. [6]. Possible Etiologies for UI may include hostile cervical mucus [7], subtle ovulatory dysfunction [8], luteal-Phase Defect [9], impaired fertilizing ability of oocytes specially when associated with raised LH levels, hyperprolactinemia [10], sperm dysfunction and antisperm Antibodies (151endometrial Steroid receptor defects [12], some genetic [13], psychological [14] or immunological Causes [15].…”