Unexplained Infertility

(And for couples being treated with Clomiphene or Pergonal*)

Unexplained Infertility refers to that group of couples who, after having gone through an infertility evaluation, either have no detectable abnormalities (rare in my practice), or whose problems do not "explain" their infertility. Early stage endometriosis is an example of a problem that fall into the latter category.

What to do with such couples has long been debated. A review of recent data has come up with numbers and statistics that offer a solution. Unfortunately, there has not yet been a properly controlled, randomized, prospective study so the recommendations I will mention here are not set in stone, but they do offer a good starting point. Some of the information here has been discussed in the preceding paragraphs.

If couples with "Unexplained Infertility" are followed, without treatment, many of them will ultimately achieve a pregnancy, but less often than "normal" couples. Various studies list the success rate as anywhere from 30% to 80%. The differences will depend on the age of the couple, the duration of their infertility, and how extensive their evaluation was before being classified as "Unexplained Infertility".

I often tell couples that based on these statistics, my therapies may not increase the likelihood of their having a baby - only how quickly they become pregnant.

You have to look at the data in several ways. You must look at the actual effectiveness of the various treatments and you must also consider the "cost per baby". As you might expect, these two outcomes are inversely related to each other.

You must also not just consider the overall pregnancy rate but the chance of conception in any one given cycle - again a reflection of what I mentioned earlier, namely that therapy will not achieve a greater chance of pregnancy, only allow it to happen more quickly.

A recent study in "Fertility and Sterility", the journal of the American Society for Reproductive Medicine lists the following data. The abbreviations used are listed at the end of this pamphlet.

Pregnancy rates per cycle:
No treatment-just observation	1.3-4.1%
IUI - only	3.8%
CC - only	5.6%
CC + IUI	8.3%
hMG - only	7.7%
hMG + IUI	17.1%
IVF	20.7%
GIFT	27%
Estimated cost of each pregnancy achieved:
CC + IUI	$10,000
hMG + IUI	$17,000
IVF	$50,000

The success rate for GIFT is somewhat higher than for IVF because couples with more severe problems have to use IVF. Only the most "ideal" couples can take advantage of GIFT. Furthermore, GIFT requires a laparoscopy, thereby increasing the cost and the risk.

One study found no real difference between the two and therefore favored IVF since it avoided the need for laparoscopy.

Based on this data (which is not new - just better summarized), I have long recommended hMG + IUI for those couples with "Unexplained Infertility". Unfortunately, what your insurance will or will not cover often mandates the treatment, not what is necessarily best for you.