Unexplained subfertility: diagnosis and management. (13th February 2016)

• Record Type: Journal Article
• Authors: Nandi, Anupa; Homburg, Roy
• Is Part Of: Obstetrician & gynaecologist. Volume 18:Number 2(2016)
• Page Start: 107
• Page End: 115
• Publication Date: 2016-02-13
• Subjects: IUI -- IVF -- unexplained infertility -- unexplained subfertility; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/tog.12253
• Languages: English
• ISSNs: 1467-2561

Abstract

Abstract : Key content: Unexplained subfertility is diagnosed when standard investigations (tests for ovulation, tubal patency and semen analysis) are all normal. Between 30% and 40% of subfertile couples fall into this category. In some couples, unexplained subfertility may result from subtle undetectable factors; in other couples, it may be associated with a genuine absence of any abnormality. There is currently much controversy about the selection of appropriate management options for such couples, especially following the National Institute for Health and Care Excellence (NICE) guideline published in 2013. Therefore, a clear understanding of the available evidence is essential for the management of couples with unexplained subfertility. The potential contributing factors, diagnosis and management of unexplained subfertility are discussed. Learning objectives: To summarise the available recent evidence and help the reader obtain a clear understanding of the continuing debates in this field. To help clinicians in counselling couples with unexplained subfertility. Ethical issues: Should couples be advised to try to conceive naturally for 2 years (regardless of their age) before they are offered treatment, even though fecundity declines with age? What does the evidence suggest should be the first line of management for couples with unexplained subfertility: intrauterine insemination or in vitro fertilisation?