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It may, at first, seem disappointing that your tests have not come up with an explanation but in terms of a successful outcome, you are more likely to achieve a pregnancy either with or without treatment than if there were evidence of severe male factor problems or tubal disease. In a summary of the available evidence, it was found that clomiphene , IUI, and HMG each double the chance of conception compared to no treatment (Figure 10.8).
Figure 10.8 Cumulative pregnancy rates for unexplained infertility.
Without treatment, IUI alone, ovarian stimulation +IUI and
IVF.
In vitro fertilisation and embryo transfer were originally developed for infertile women who had no Fallopian tubes or who had tubes that were irreversibly damaged. IVF and GIFT (gamete intra Fallopian transfer eggs and sperm are introduced into the Fallopian Tubes) have found places for other causes of infertility including male factor and unexplained infertility. IVF and GIFT include superovulation (increase in the number of oocytes available for fertilisation), and increasing the number of spermatozoa directly available for each oocyte. For women with no evidence of gross tubal disease, superovulation (gonadotrophin injections) and intrauterine insemination could provide some of the advantages of IVF or GIFT but with less invasive procedures and at lower cost.
Some authorities have recommended that IUI and gonadotrophin injections should be offered to couples with unexplained infertility before submitting them to IVF. A successful outcome is more likely with four courses of this combination than one course of IVF and this low-tech approach is also more cost-effective. Patients with unexplained infertility, who fail to conceive with IUI and superovulation, prove to have a higher incidence of fertilisation failure when they are treated by IVF than patients with tubal factor infertility.
Related Medical Abstracts - Click on the paper title:-
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