Abstract
Unexplained infertility is a common diagnosis among couples with infertility. Pragmatic
treatment options in these couples are directed at trying to improve chances to conceive,
and consequently intrauterine insemination (IUI) with ovarian stimulation and in vitro
fertilization (IVF) are standard clinical practice, while expectant management remains
an important alternative. While evidence on IVF or IUI with ovarian stimulation versus
expectant management was inconclusive, these interventions seem more effective in
couples with a poor prognosis of natural conception. Strategies such as strict cancellation
criteria and single-embryo transfer aim to reduce multiple pregnancies without compromising
cumulative live birth. We propose a prognosis-based approach to manage couples with
unexplained infertility so as to expose less couples to unnecessary interventions
and less mothers and children to the potential adverse effects of ovarian stimulation
or laboratory procedures.
Keywords
unexplained infertility - expectant management - intrauterine insemination - in vitro
fertilization - cost-effectiveness - safety
