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: 1.33). 03/2003; 267(4):177-88. DOI: 10.1007/s00404-002-0300-0
Source: PubMed

ABSTRACT 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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    ABSTRACT: This study was designed to evaluate the role of hysteroscopy and endometrial biopsy in women with unexplained infertility. Women with unexplained infertility were included in this prospective study, evaluated with transvaginal sonography and diagnostic hysteroscopy. Diagnostic hysteroscopy was performed between the 7th and 11th day of the cycle. The criteria for hysteroscopic findings were based on the cervical canal, uterine cavity, endometrium, visualization of the ostium tubae and lesions of the utero-tubal junction. After the hysteroscopic examination, endometrial biopsy was performed using a Pipelle(®) endometrial suction curette. Patients were classified according to the hysteroscopy results into four groups: patients with no abnormality detected (14), patients with cervical abnormalities (six), patients with endometrial abnormalities (73) and patients with uterine abnormalities (seven). One hundred women with unexplained infertility were included. All patients underwent diagnostic hysteroscopy, except for seven patients: six patients had stenotic external or internal cervical ostium and one had inadequate visualization as the uterine cavity was filled with blood. Based on hysteroscopic findings, 31 patients were finally diagnosed with endometrial polyps; 14 endometritis; 15 endometrial hyperplasia; six submucous myomas; seven intrauterine synechiae (73 cases = endometrial abnormalities group); seven congenital uterine anomalies (uterine abnormalities group), six cervical stenosis (cervical abnormalities group) and 14 women without any uterine abnormalities (no abnormalities group). Analysis of samples obtained using the Pipelle(®) endometrial suction curette was non-diagnostic in 16 cases; the most common endometrial pathological feature detected by this analysis was endometritis (15 %). Routine hysteroscopy and endometrial biopsy should be used as a basic part of the work-up for women with unexplained infertility.
    Archives of Gynecology 07/2013; · 0.91 Impact Factor
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    ABSTRACT: Unexplained male infertility is a diagnosis reserved for men in whom routine semen analyses results are within normal values and physical as well as endocrine abnormalities were ruled out. In addition to erectile problems and coital factors, immunologic causes and sperm dysfunction may contribute to such condition. New etiologies of unexplained male infertility include low level leukocytospermia and mitochondrial DNA polymerase gene polymorphism. Contemporary andrology may reveal cellular and sub-cellular sperm dysfunctions which may explain subfertility in such cases, thus aiding the clinician to direct the further work-up, diagnosis and counseling of the infertile male. The objective of this article is to highlight the concept of unexplained male infertility and focuses on the diagnosis and treatment of this condition in the era of modern andrology and assisted reproductive techniques. Extensive literature review was performed using the search engines: Pubmed, Science-direct, Ovid and Scopus.
    International braz j urol 10/2012; 38(5):576-594. · 0.74 Impact Factor
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    ABSTRACT: Study objective To assess the association between the first trimester miscarriage rates among women undergoing intracytoplasmic sperm injection (ICSI) and underlying etiology of infertility. Design Prospective cohort study. Setting Ain Shams University maternity hospital. Materials and methods The study included women who became pregnant with singleton pregnancy following ICSI as a treatment for different causes of infertility. Women were followed up throughout the first trimester of pregnancy up to 12 weeks’ gestation (10 weeks after the day of embryo transfer). Main outcome measure First trimester miscarriage rate. Results Two hundred and thirty four pregnant young women were included in the study, 164 (70.9%) women miscarried. The causes of infertility among these women were as follows: 41 (25%) mild male factor infertility, 40 (24.4%) severe male factor infertility, 45 (27.44%) tubal factor, 7 (4.27%) polycystic ovarian syndrome, 3 (1.83%) endometriosis, 20 (12.19%) unexplained and 8 (4.87%) multifactorial. Stepwise logistic multi-regression analysis showed that both maternal age (>31 years) and tubal block were the most sensitive discriminators for the prediction of first trimester spontaneous miscarriage among the study population (P < 0.01). Major conclusions First trimester spontaneous miscarriage rates among pregnant women with singleton pregnancy following ICSI were related to maternal age >31 years and/or the presence of tubal block.
    Middle East Fertility Society Journal 01/2013;


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