Diagnosis and management of unexplained infertility: An update

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. inclusion of many normally fertile couples. This will result in a higher incidence of unexplained infertility. So far, there is no agreement neither regarding standard infertility evaluation [4] nor regarding standard protocol of management of unexplained infertility [5]. Variation in the way different investigators interpret their data, together with the difficulty in performing prospective randomised trials have resulted in today's differences in opinion and practice among specialists. This article is presented to track the best available evidence regarding different diagnostic and treatment modalities of unexplained infertility.