Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
Centre for Reproductive Medicine, Amsterdam UMC, Amsterdam, The Netherlands.
Semin Reprod Med. 2020 Jan;38(1):48-54. doi: 10.1055/s-0040-1719074. Epub 2020 Oct 29.
Unexplained infertility is a common diagnosis among couples with infertility. Pragmatic treatment options in these couples are directed at trying to improve chances to conceive, and consequently intrauterine insemination (IUI) with ovarian stimulation and in vitro fertilization (IVF) are standard clinical practice, while expectant management remains an important alternative. While evidence on IVF or IUI with ovarian stimulation versus expectant management was inconclusive, these interventions seem more effective in couples with a poor prognosis of natural conception. Strategies such as strict cancellation criteria and single-embryo transfer aim to reduce multiple pregnancies without compromising cumulative live birth. We propose a prognosis-based approach to manage couples with unexplained infertility so as to expose less couples to unnecessary interventions and less mothers and children to the potential adverse effects of ovarian stimulation or laboratory procedures.
不明原因不孕是不孕夫妇的常见诊断。对于这些夫妇，实用的治疗选择旨在提高受孕机会，因此宫腔内人工授精（IUI）联合卵巢刺激和体外受精（IVF）是标准的临床实践，而期待治疗仍然是一种重要的选择。虽然关于 IVF 或 IUI 联合卵巢刺激与期待治疗的证据尚无定论，但这些干预措施在自然受孕预后较差的夫妇中似乎更有效。严格的取消标准和单胚胎移植等策略旨在减少多胎妊娠，而不影响累积活产。我们提出了一种基于预后的方法来管理不明原因不孕的夫妇，以使较少的夫妇接受不必要的干预，较少的母亲和孩子受到卵巢刺激或实验室程序的潜在不良影响。
