TY - JOUR
T1 - Evidence-based treatments for couples with unexplained infertility
T2 - a guideline
AU - Practice Committee of the American Society for Reproductive Medicine
AU - Penzias, Alan
AU - Bendikson, Kristin
AU - Falcone, Tommaso
AU - Hansen, Karl
AU - Hill, Micah
AU - Jindal, Sangita
AU - Mersereau, Jennifer
AU - Racowsky, Catherine
AU - Rebar, Robert
AU - Steiner, Anne Z.
AU - Stovall, Dale
AU - Tanrikut, Cigdem
AU - Kalra, Suleena
AU - Reindollar, Richard
AU - Hurd, William
N1 - Publisher Copyright:
© 2019 American Society for Reproductive Medicine
PY - 2020/2
Y1 - 2020/2
N2 - 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.
AB - 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.
KW - Unexplained infertility
KW - in vitro fertilization
KW - intrauterine insemination
KW - multiple pregnancy
KW - ovarian stimulation
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U2 - 10.1016/j.fertnstert.2019.10.014
DO - 10.1016/j.fertnstert.2019.10.014
M3 - Article
C2 - 32106976
AN - SCOPUS:85079908679
SN - 0015-0282
VL - 113
SP - 305
EP - 322
JO - Fertility and sterility
JF - Fertility and sterility
IS - 2
ER -