Diagnosis and management of unexplained infertility: An update

The Egyptian IVF-ET Center, 3 Street 161, Hadayek El-Maadi, Maadi, Cairo 11431, Egypt.
Archives of Gynecology and Obstetrics (Impact Factor: 1.36). 03/2003; 267(4):177-88. DOI: 10.1007/s00404-002-0300-0
Source: PubMed


Unexplained infertility constitutes around 15% of patients presenting with infertility. A lack of agreement exists among infertility specialists with regard to the diagnostic tests to be performed and their prognostic value as well as criteria of normality. It seems that serum progesterone for detection of ovulation, hysterosalpingography and or laparoscopy for tubal patency and semen analysis are the basic tests for diagnosis of unexplained infertility. Expectant treatment is the option of choice for young patients with short period of infertility. The spontaneous pregnancy rate is very high in this group of patients. The world literature have shown that controlled ovarian hyperstimulation and intrauterine insemination (COH and IUI) is an effective treatment of unexplained infertility. According to the available data, this procedure could be limited to three trials. There is evidence that both COH and IUI are important independent positive factors in achieving better pregnancy rate in unexplained infertility. If the above measures fail to achieve pregnancy, GIFT or IVF/ICSI could be performed as it yields a high pregnancy rate.

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Available from: Ragaa Mansour, Sep 22, 2014
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    ABSTRACT: Infertility has always been defined with respect to a number of parameters prominent amongst which are time, causes, treatment cost and socio-cultural implications. The most widely accepted practical classifications distinguishes between primary and secondary infertilities with a further sub classification into 3 clearly defined groups that include ovulatory dysfunction, fallopian tube compromise , male factor ( sperm function and delivery disorder) alongside an ambiguous and controversial group labeled as "unexplained infertility". Recent technological developments in the fields of optics, video-imaging and miniaturized surgical instruments, have lead to the emergence of minimal access procedures, with wide and varied applications in the field of gynaecology. The skill in its different forms and various combination modalities is widely applied in the management of the infertile couple especially those with tubal infertility. The economic and safety records of endoscopic procedures are well documented in other surgical acts. Gynaecology in general and tubal infertility in particular, does not seem to constitute an exception, more so when their cost-effective ratio is considered alongside results. The different forms of endoscopic procedures have been shown to de-mystify and redefine the bounds of "unexplained infertility" by producing new diagnostic evidence. Novel minimal access surgical procedures have been shown to play not only a preventive but also a curative role in tubo-peritoneal infertility as well as other forms of infertility. In skilled hands, the various forms of endoscopic procedures can be combined in different ways to improve on the diagnosis and treatment afflicted patients. This management style referred to by some authors as "fertiloscopy" judiciously blends the use of laparoscopy, hysteroscopy, salpingoscopy, fimbroscopy and chromotubation with other conventional infertility work-up procedures to resolve infertility problems with very promising results. Infertility, its work-up and treatment are quite often time consuming with all the consequences, economic, social and particularly psychological attached to it. The ergonomics' of infertility management has developed over time and has come up with the one-stop shop model for infertile couples. Minimal access procedures are apparently set to play a central and determinant role. With this in mind, the need to overview the path covered this far and also ponder on future orientations in view of improving on results can not be over emphasized. AIM OF STUDY In this study, we intended to high-light the capital and central role that minimal access or endoscopic procedures play in the management of tubal infertily as well as demonstrate the positive impact it has both in the fight against infertility and redefining the classification of the pathology.
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