Role of in vitro fertilization in unexplained female infertility

Abstract

There is no established definition for "unexplained female infertility." Nevertheless, various treatment modalities have been offered to couples in whom no cause of infertility was found after thorough evaluation. Evidence shows that in vitro fertilization (IVF) is an effective treatment for unexplained infertility, and is associated with higher clinical pregnancy and live birth rates compared to expectant management. Current evidence also shows that intrauterine insemination (IUI) with or without controlled ovarian hyperstimulation (COH) may be equally effective in treatment-naïve patients, but this information is based on small studies and larger randomized controlled trials (RCTs) are needed. In pretreated patients, IVF is associated with significantly higher clinical pregnancy and live birth rates compared to IUI. Performing ICSI and IVF on sibling oocytes can help clarify the cause of infertility, and ICSI is associated with a significantly higher fertilization rate compared to standard IVF. The cost of achieving a live birth through IVF is higher than with IUI, but this should be seen in the light of the time needed to achieve the pregnancy.