Shingshetty Laxmi, Maheshwari Abha, McLernon David J, Bhattacharya Siladitya
Aberdeen Centre for Reproductive Medicine, NHS Grampian, Aberdeen, UK.
Medical Statistics Team, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
Hum Reprod Open. 2022 Oct 13;2022(4):hoac046. doi: 10.1093/hropen/hoac046. eCollection 2022.
The treatment of unexplained infertility is a contentious topic that continues to attract a great deal of interest amongst clinicians, patients and policy makers. The inability to identify an underlying pathology makes it difficult to devise effective treatments for this condition. Couples with unexplained infertility can conceive on their own and any proposed intervention needs to offer a better chance of having a baby. Over the years, several prognostic and prediction models based on routinely collected clinical data have been developed, but these are not widely used by clinicians and patients. In this opinion paper, we propose a prognosis-based approach such that a decision to access treatment is based on the estimated chances of natural and treatment-related conception, which, in the same couple, can change over time. This approach avoids treating all couples as a homogeneous group and minimizes unnecessary treatment whilst ensuring access to those who need it early.
不明原因不孕症的治疗是一个颇具争议的话题，一直吸引着临床医生、患者和政策制定者的广泛关注。由于无法确定潜在的病理原因，因此难以设计出针对这种情况的有效治疗方法。患有不明原因不孕症的夫妇可能会自然受孕，任何提议的干预措施都需要提供更高的生育几率。多年来，已经开发了几种基于常规收集的临床数据的预后和预测模型，但临床医生和患者并未广泛使用这些模型。在这篇观点论文中，我们提出了一种基于预后的方法，即根据自然受孕和治疗相关受孕的估计几率来决定是否接受治疗，而对于同一对夫妇来说，这些几率可能会随时间变化。这种方法避免将所有夫妇视为一个同质群体，尽量减少不必要的治疗，同时确保需要治疗的人能够尽早获得治疗。
