Zayed F, Abu-Heija A
Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Amman, Jordan.
Obstet Gynecol Surv. 1999 Feb;54(2):121-30. doi: 10.1097/00006254-199902000-00022.
Unexplained infertility is a diagnosis made by exclusion after all of the standard investigations have revealed no abnormality (1). The range of the prevalence is from 6 to 60 percent (23), depending on the diagnostic criteria. This article reviews the literature in the management of unexplained infertility; published data suggest no benefit of danazol or bromocriptine. The empirical use of clomiphene citrate suggests that ovarian stimulation using clomiphene citrate can double the spontaneous pregnancy rate (52, 58, 59). Induction of ovulation with human menopausal gonadotrophin (hMG) yields an overall pregnancy rate between 2 and 26 percent per cycle (68, 74). These results seem to be lower than those reported for in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) procedures in similar patients (25-30 percent (92, 95)). Based on the literature, a rational treatment plan for treating infertility in couples with unexplained infertility includes up to four cycles of clomiphene citrate with or without intrauterine insemination (IUI). Superovulation with hMG and IUI or stimulated intrauterine insemination (SIUI) is the next step for three-cycle treatments and if unsuccessful, one of the variants of assisted reproductive techniques (ART) should be considered.
Obstetricians & Gynecologists, Family Physicians.
After completion of this article, the reader will understand the appropriate tests and work up for unexplained infertility, the various treatment options for the unexplained infertility couple including which drugs are effective and not effective, and to be able to outline an appropriate treatment plan for such patients.
不明原因不孕症是在所有标准检查均未发现异常后通过排除法做出的诊断（1）。患病率范围为6%至60%（23），具体取决于诊断标准。本文回顾了不明原因不孕症治疗方面的文献；已发表的数据表明，达那唑或溴隐亭并无益处。枸橼酸氯米芬的经验性使用表明，使用枸橼酸氯米芬进行卵巢刺激可使自然妊娠率翻倍（52、58、59）。用人绝经期促性腺激素（hMG）诱导排卵，每个周期的总体妊娠率为2%至26%（68、74）。这些结果似乎低于类似患者体外受精（IVF）或配子输卵管内移植（GIFT）手术报告的结果（25% - 30%（92、95））。根据文献，针对不明原因不孕症夫妇治疗不孕症的合理治疗方案包括进行多达四个周期的枸橼酸氯米芬治疗，可联合或不联合宫腔内人工授精（IUI）。对于三个周期治疗后仍未成功的患者，下一步是采用hMG进行超促排卵并联合IUI或刺激宫腔内人工授精（SIUI），若仍未成功，则应考虑辅助生殖技术（ART）的其中一种变体。
产科医生和妇科医生、家庭医生。
阅读本文后，读者将了解不明原因不孕症的适当检查和诊断方法、不明原因不孕症夫妇的各种治疗选择，包括哪些药物有效和无效，并能够为这类患者制定适当的治疗方案。
