Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, PO Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands.
Hum Reprod. 2011 Feb;26(2):360-8. doi: 10.1093/humrep/deq349. Epub 2010 Dec 16.
Unexplained infertility is one of the most common diagnoses in fertility care. The aim of this study was to evaluate the outcome of current fertility management in unexplained infertility.
In an observational, longitudinal, multicentre cohort study, 437 couples were diagnosed with unexplained infertility and were available for analysis. They were treated according to their prognosis using standing national treatment protocols: (i) expectant management-IUI-IVF (main treatment route), (ii) IUI-IVF and (iii) directly IVF. Primary outcome measures were: ongoing pregnancy rate, patient flow over the strategies, numbers of protocol violation and drop out rates. A secondary outcome measure was the prediction of ongoing pregnancy and mode of conception.
Of all couples 81.5% (356/437) achieved an ongoing pregnancy and 73.9% (263/356) of the pregnancies were conceived spontaneously. There were 408 couples (93.4%) in strategy-1, 21 (5.0%) in strategy-2 and 8 (1.8%) in strategy-3. In total, 33 (7.6%) couples entered the wrong strategy. There were 104 couples (23.8%) who discontinued fertility treatment prematurely: 26 on doctor's advice (with 4 still becoming pregnant) and 78 on their own initiative (with 33 still achieving a pregnancy). Predictors for overall pregnancy chance and mode of conception were duration of infertility, female age and obstetrical history.
Overall success rate in couples with unexplained infertility is high. Most pregnancies are conceived spontaneously. We recommend that if the pregnancy prognosis is good, expectant management should be suggested. The prognosis criteria for treatment with IUI or IVF needs to be investigated in randomized controlled trials.
不明原因不孕是生育保健中最常见的诊断之一。本研究旨在评估目前对不明原因不孕的生育管理的结果。
在一项观察性、纵向、多中心队列研究中，437 对夫妇被诊断为不明原因不孕，可进行分析。根据其预后，采用现行国家治疗方案进行治疗：（i）期待管理-IUI-IVF（主要治疗途径）、（ii）IUI-IVF 和（iii）直接 IVF。主要结局指标为：持续妊娠率、策略间患者流动、方案违反和退出率。次要结局指标为持续妊娠和受孕方式的预测。
所有夫妇中，81.5%（356/437）实现了持续妊娠，73.9%（263/356）的妊娠为自然受孕。策略 1 中有 408 对夫妇（93.4%），策略 2 中有 21 对（5.0%），策略 3 中有 8 对（1.8%）。共有 33 对夫妇（7.6%）进入错误的策略。共有 104 对夫妇（23.8%）过早停止生育治疗：26 对是根据医生的建议（其中 4 对仍怀孕），78 对是自行决定（其中 33 对仍怀孕）。总共有 104 对夫妇（23.8%）过早停止生育治疗：26 对是根据医生的建议（其中 4 对仍怀孕），78 对是自行决定（其中 33 对仍怀孕）。总共有 104 对夫妇（23.8%）过早停止生育治疗：26 对是根据医生的建议（其中 4 对仍怀孕），78 对是自行决定（其中 33 对仍怀孕）。预测整体妊娠机会和受孕方式的因素是不孕持续时间、女性年龄和产科病史。
不明原因不孕夫妇的总成功率较高。大多数妊娠为自然受孕。我们建议，如果妊娠预后良好，应建议期待治疗。IUI 或 IVF 治疗的预后标准需要在随机对照试验中进行研究。
