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Evidence-based treatments for couples with unexplained infertility: a guideline.

Publication ,  Journal Article
Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, ...
Published in: Fertil Steril
February 2020

OBJECTIVE: To provide evidence-based recommendations to practicing physicians and others regarding the effectiveness and safety of therapies for unexplained infertility. METHODS: ASRM conducted a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1968 through 2019. The ASRM Practice Committee and a task force of experts used available evidence and informal consensus to develop evidence-based guideline recommendations. MAIN OUTCOME MEASURE(S): Outcomes of interest included: live-birth rate, clinical pregnancy rate, implantation rate, fertilization rate, multiple pregnancy rate, dose of treatment, rate of ovarian hyperstimulation, abortion rate, and ectopic pregnancy rate. RESULT(S): The literature search identified 88 relevant studies to inform the evidence base for this guideline. RECOMMENDATION(S): Evidence-based recommendations were developed for the following treatments for couples with unexplained infertility: natural cycle with intrauterine insemination (IUI); clomiphene citrate with intercourse; aromatase inhibitors with intercourse; gonadotropins with intercourse; clomiphene citrate with IUI; aromatase inhibitors with IUI; combination of clomiphene citrate or letrozole and gonadotropins (low dose and conventional dose) with IUI; low-dose gonadotropins with IUI; conventional-dose gonadotropins with IUI; timing of IUI; and in vitro fertilization and treatment paradigms. CONCLUSION(S): The treatment of unexplained infertility is by necessity empiric. For most couples, the best initial therapy is a course (typically 3 or 4 cycles) of ovarian stimulation with oral medications and intrauterine insemination (OS-IUI) followed by in vitro fertilization for those unsuccessful with OS-IUI treatments.

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Published In

Fertil Steril

DOI

EISSN

1556-5653

Publication Date

February 2020

Volume

113

Issue

2

Start / End Page

305 / 322

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Insemination, Artificial
  • Infertility, Female
  • Humans
  • Gonadotropins
  • Fertilization in Vitro
  • Female
  • Evidence-Based Practice
 

Citation

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Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, ., & Practice Committee of the American Society for Reproductive Medicine, . (2020). Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril, 113(2), 305–322. https://doi.org/10.1016/j.fertnstert.2019.10.014
Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, James, and James Practice Committee of the American Society for Reproductive Medicine. “Evidence-based treatments for couples with unexplained infertility: a guideline.Fertil Steril 113, no. 2 (February 2020): 305–22. https://doi.org/10.1016/j.fertnstert.2019.10.014.
Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020 Feb;113(2):305–22.
Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, James, and James Practice Committee of the American Society for Reproductive Medicine. “Evidence-based treatments for couples with unexplained infertility: a guideline.Fertil Steril, vol. 113, no. 2, Feb. 2020, pp. 305–22. Pubmed, doi:10.1016/j.fertnstert.2019.10.014.
Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020 Feb;113(2):305–322.
Journal cover image

Published In

Fertil Steril

DOI

EISSN

1556-5653

Publication Date

February 2020

Volume

113

Issue

2

Start / End Page

305 / 322

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Insemination, Artificial
  • Infertility, Female
  • Humans
  • Gonadotropins
  • Fertilization in Vitro
  • Female
  • Evidence-Based Practice