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How do you treat unexplained infertility?

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1 fertility expert(s) answered this question

Answer from: Jane Stewart, MD

Gynaecologist, Consultant in Reproductive Medicine and Gynaecology at Newcastle’s Fertility Centre
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Our normal approach would be to try and maximise the chances of conception naturally. Although that label is often given at the one year mark that is relatively early, if you’re looking at the statistics and so, 2 years is not an unreasonable time for couples to try for a pregnancy if everything is otherwise okay. At that time you have probably maximised your chances pretty well, there is still an ongoing chance, but our practice then would be to move to IVF treatment and the rationale for that is because if there are subtle things going on, we are putting eggs and sperm together in the lab and we’re understanding what is going on from the fertilisation point of view. We’re bypassing the fallopian tubes, so if there are subtle things going on we are bypassing that. We learn things about these people whilst taking them through that process and hopefully enhancing their chance of success. People have in the past used ovulation induction drugs to try to improve their chances and I believe the rationale for that is poor. Clomiphene is traditionally used in that setting but if you are ovulating already, how does clomiphene make you ovulate better and in fact it probably has better impacts including on cycle mucus and possibly endometrium that might actually make it harder for them to conceive in that setting. Although people will conceive whether their chances are better than doing nothing is debatable and the only good trial, done in Aberdeen some years ago, suggests that there was no benefit in doing that. The other treatment that people often understake is uterine insemination which is much more controversial. There are people who are more in favour of that and others who are less so, the original data was not great as there were no good control trials going on to suggest that there was a benefit on what people were doing on their own as opposed to just having data from treatment. In those studies years ago they were using drugs to enhance ovulation, often taking big risks with multiple pregnancies and if you reduce the risk of multiple pregnancies down you wont gain so much. There have been newer trials form Europe suggesting benefits, but they treat people earlier there so they are starting to treat them at one year. Whilst there might be some benefit in that, that is tying people into treatment at a very early stage in the process when they still have a vary good chance of conceiving on their own. It’s difficult to know entirely what is the best thing to do if you don’t know what the problem is. Talking about risks and chances our preferred process to maximise your chances naturally are to keep out of the hospital setting as long as possible and then move to IVF at the 2 year mark.

About this question:

What are the diagnosis and treatment approaches to unexplained infertility?

What are treatments for infertility? Are the medication, surgery, ART the only options? May a dietary changes, acupuncture or alternative medicine be of help?

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