Three-quarters of couples suffering from unexplained infertility will probably conceive from treatment if doctors follow a 'gold standard' regimen, according to American fertility specialist Professor Michael Soules.
However, he warned the conference of the European Society of Human Reproduction and Embryology in Bologna, Italy, today, (Wednesday 28 June) that wise doctors should remain humble about their 'success' as they could never be certain that conception would not have happened spontaneously anyway.
One in six couples worldwide experience some form of infertility problem and in about 5-10% of these no apparent cause can be found.
Professor Soules, director of the Division of Reproductive Endocrinology in the Department of Obstetrics and Gynaecology at the University of Washington in Seattle, said:"Unexplained fertility is like pre-menstrual syndrome in that the disease is not defined. You are presented with a couple whose tests show nothing is apparently amiss and you have to tell them that you are approaching their treatment from a perspective of medical ignorance when it comes to the cause of their problem."
He said that a watch-and-wait approach for 6 to 12 months was justified in couples under 35 who had been trying to conceive for less than two years; in the case of a couple over 35 who had been trying for more than three years, immediate aggressive treatment was appropriate.
The first step though was careful evaluation to make sure no subtle causes of infertility had been overlooked -- conditions such as inflammation of the cervix or lining of the womb, antibodies to the sperm or problems involving implantation of the embryo immediately after fertilisation
Then treatment should follow five escalating steps:
- a course of antibiotics (tetracycline or doxycycline) for both partners +
- three attempts at intra-uterine insemination (IUI) +
- clomiphene citrate (a drug used to stimulation ovulation) + IUI for three cycles*
- gonadotropins (ovarian stimulatory hormones) + IUI for three cycles*
- IVF with ICSI (the technique of injecting a single sperm directly into a woman's egg)*
"In my experience about 75% of couples with unexplained infertility will conceive following this programme. However, it is wise to remain humble, as you cannot be certain that any particular pregnancy that is achieved would not have occurred spontaneously," said Professor Soules.
Notes: programme number: O-213
+ = empirical recommendations
* = proven recommendations in unexplained fertility
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