Evidence-based Treatments for Couples with Unexplained Infertility
Publication Date: February 1, 2020
Last Updated: November 30, 2023
RECOMMENDATIONS
It is not recommended to perform IUI in natural cycles for the treatment of unexplained infertility. It is less effective than OS with IUI and likely no more effective than expectant management. (I, Strong)
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It is not recommended to use clomiphene citrate with timed intercourse as a treatment for unexplained infertility, as it is no more effective than expectant management. (II, Moderate)
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It is not recommended to use letrozole with timed intercourse as a treatment for unexplained infertility, as it is no more effective than expectant management. (II, Moderate)
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It is not recommended to use gonadotropins with timed intercourse in the treatment of unexplained infertility. Studies report either no difference in pregnancy outcomes compared to OS with oral agents or higher pregnancy rates associated with a higher risk of multiple-gestation pregnancy. (II, Moderate)
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It is recommended to use clomiphene citrate with IUI in the treatment of couples with unexplained infertility. (I, Strong)
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It is recommended that letrozole with IUI treatments be considered as an alternative regimen for couples with unexplained infertility, as studies to date suggest similar efficacy. Of note, letrozole is not FDA approved for treatment of unexplained infertility but is considered an effective and well tolerated option. (I, Strong)
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It is not recommended to use letrozole or clomiphene citrate plus conventional-dose gonadotropins with IUI, as most studies associated with improved pregnancy rate over OS-IUI with oral medications are also associated with an increased risk of multiple-gestation pregnancy. (II, Moderate)
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It is not recommended to use low-dose gonadotropins with IUI in the treatment of unexplained infertility, as it is more complex and expensive, and likely no more effective than OS with oral medications with IUI. (II, Moderate)
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It is not recommended to use conventional-dose gonadotropins with IUI, as most studies associated with improved pregnancy rate over OS-IUI with oral medications are also associated with a high multiple-gestation pregnancy rate. (I, Strong)
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It is recommended that a single IUI be performed between 0 and 36 hours relative to hCG injection in OS with IUI treatments. (II, Moderate)
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It is recommended that couples with unexplained infertility initially undergo a course (typically 3 or 4 cycles) of OS and IUI with oral agents. For those unsuccessful with OS and IUI treatments with oral agents, IVF is recommended rather than OS and IUI with gonadotropins. (II, Moderate)
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Title
Evidence-based Treatments for Couples with Unexplained Infertility
Authoring Organization
American Society for Reproductive Medicine
Publication Month/Year
February 1, 2020
Last Updated Month/Year
February 5, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
To provide evidence-based recommendations to practicing physicians and others regarding the effectiveness and safety of therapies for unexplained infertility.
Target Patient Population
Couples experience unexplained infertility
Inclusion Criteria
Male, Female, Adult
Health Care Settings
Ambulatory, Laboratory services, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Counseling, Treatment, Management
Diseases/Conditions (MeSH)
D007246 - Infertility, D007247 - Infertility, Female, D007248 - Infertility, Male
Keywords
infertility, ovarian stimulation
Source Citation
Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org; Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020 Feb;113(2):305-322. doi: 10.1016/j.fertnstert.2019.10.014. PMID: 32106976.
Methodology
Number of Source Documents
157
Literature Search Start Date
December 19, 2017
Literature Search End Date
August 7, 2019