A condition in which pregnancy does not occur in the absence of obvious reasons is called unexplained infertility. Its other names are unexplained or idiopathic infertility. As such, there is no diagnosis, and the diagnosis in this case is made by exclusion, after all the examinations performed.
A diagnosis of “unexplained infertility” does not always mean that the couple’s reproductive health is fine. In some cases, an objective reason for the impossibility of conception still exists, but it is very difficult to identify it using the diagnostic tools available to doctors. Conditions for making such a diagnosis the following:
If standard procedures no violations were found,
Diagnosis of infertility of unknown origin requires additional examinations
patients may be prescribed additional research to find out the causes of infertility. Among them,
For example:
— HLA typing – antigen compatibility analysis;
— analysis for carriage of the Leiden mutation (pathology in the blood coagulation system);
- exception antiphospholipid syndrome, in which antibodies appear in the blood, promoting the development of thrombosis;
— analysis for genetic defects of folate cycle enzymes;
— pipel biopsy – examination of a sample of endometrial tissue;
— analysis for the content of inhibin-b, a protein that is involved in regulating the process of maturation of germ cells.
Changes in these indicators can affect the ability to conceive - for example, cause a decrease in the sensitivity of the uterine mucosa, as a result of which blastocyst implantation does not occur.
As a rule, treatment of infertility of unknown origin involves
In vitro fertilization is the most effective way treatment of infertility of unknown origin application of several tactics and methods:
Patients talk about what non-obvious and difficult-to-identify reasons lead to the inability to get pregnant and what to do in case of infertility of unknown origin:
Oksana:“For five years of attempts, torment and examinations, my husband and I have not found a single reason. They said that all the reasons are in our heads. In the end, I decided to go for IVF. As soon as I got ready, it turned out that I was four weeks pregnant.”
Kate:“We are both healthy, my tubes are clear, my hormones are in place, my husband’s sperm is almost like donor sperm. It didn’t work out and that’s it. I was stimulated to ovulate three times, then there were two artificial insemination, then two IVFs. It worked the second time.”
Natalia:“From my experience I concluded that there is no infertility of unknown origin. There is only, let's say, an underexplored genesis. We tried for 6 years, nothing worked and we couldn’t find a reason. They didn’t give directions for IVF; they said there was no indication. Isn’t 6 years of trying an indication?”
Masha:“I really regret that I didn’t go for IVF earlier, I lost so many years. First I measured basal temperature and took pills (such as dietary supplements), then they were stimulated, then there were laparoscopic and hysteroscopies, the result was zero. Then there were five IVF attempts, all unsuccessful. Only on the 6th attempt did they get a son and a daughter. As a result, my treatment took 12 years.”
Julia:“Everything has already been examined up and down, but the reason has not been found. I've already changed clinics twice, to no avail. I did insemination 4 times, to no avail. Now they have prescribed a pipette biopsy, because they say that some forms of endometriosis are not visible in other studies.”
Sveta:“I recommend everyone to check inhibin-b. I had two diagnostic operations, after them the follicles grew to 25 millimeters, but there was no pregnancy. It turned out that they were large, but empty; the egg did not mature. And all because very little inhibin-b was produced.”
Thus, infertility of unknown origin is one of the most difficult diagnoses in reproductive medicine, requiring a long and painstaking examination. And the most effective way to conceive a child in this case is in vitro fertilization.
Unexplained infertility, otherwise known as idiopathic or unexplained infertility, means that after extensive examination of the man and woman, the cause of the infertility has not been found. This diagnosis is made by exclusion - that is, only after everything necessary examinations were carried out and their results were normal.
The diagnosis of “idiopathic infertility” can only be made if the following conditions are present:
This diagnosis cannot be made unless the woman has had a diagnostic laparoscopy because some causes of infertility, such as endometriosis, can only be diagnosed during surgery.
[*]for a man:
[*]Sexual intercourse occurs quite often, especially during the period of ovulation, and spouses try to conceive for at least a year.
Patients diagnosed with unexplained infertility can be divided into two groups. The first group does not have any problems with fertility, they are simply “unlucky yet.” The second group actually has an objective cause of infertility, but it cannot be identified by modern diagnostic methods, or it is still unknown to scientists. The diagnosis of “unexplained infertility” is a recognition of the imperfection of diagnostic capabilities modern medicine. Just 30-40 years ago, the diagnosis of “idiopathic infertility” was given to approximately half of married couples. As it develops diagnostic methods this number has steadily declined and is now around 10%.
In reality, there may be hundreds or even thousands of possible causes of infertility because many events must happen in perfect sequence for conception to occur, and the child was born. In simplified form it looks like this:
If this chain is broken in any of the links, it will lead to the impossibility of conception.
The above model is extremely simplified, but we think the general meaning is clear to you. Literally hundreds of molecular and biochemical events and transformations must occur in a timely manner for pregnancy to occur. Standard examination in case of infertility, it affects these mechanisms very superficially, trying to identify only the most gross and obvious pathologies, such as blocked fallopian tubes, reduced sperm count, irregular ovulation etc. This examination practically does not affect events occurring at the molecular level. Apparently this is a matter of the future.
1. What is the problem if everything is fine?
Infertility is surrounded a huge amount assumptions, myths, hopes and fears. An almost endless list of factors is cited as reasons that influence fertility in one way or another. They include almost every aspect of life, ranging from diet, lifestyle and influence environment, and ending with thoughts and psychological state. Probably, there is not a single area in the body of a woman and a man, in their consciousness, lifestyle and relationships, which would not be suspected as possible reason infertility.
Most of these assumptions have not been thoroughly tested. Some substances or activities are included in the list of potential "causes" of infertility only because they are more common in people with infertility than in other people. However, infertility itself is quite common, which means that a very large number of observations are required to establish a possible connection, because people can have a lot in common beyond infertility simply by coincidence.
A diagnosis of unexplained infertility implies that there is something wrong with the gametes (egg and sperm), their interaction with each other, or their interaction with reproductive system women. In short, in the case of unexplained infertility, we can assume that the sperm, although looking absolutely normal under the microscope, are not performing their function (fertilization). We are not sure that the fertilized egg (zygote, embryo) divides normally and has no pathologies. We are not sure that the membrane of the egg (zona pellucida) is not too thick or dense, preventing the embryo from breaking it and coming out.
Unexplained infertility means that there is a problem in the process of conception that we cannot detect unless we do in vitro fertilization (we obtain eggs from the ovary and see problems with fertilization, embryo division and membrane thickness directly in the laboratory). At the same time, in vitro fertilization does not always help determine the cause of infertility, although it gives spouses the opportunity to have a child with a very high probability.
2. What can be done to help patients with unexplained infertility?
Most patients worry that because we can't find the cause of their infertility, we won't be able to help them get pregnant through IVF. Fortunately, today this is not the case, because our technologies in overcoming infertility are significantly superior to those in diagnosing its causes. In the end, most infertile couples are interested not so much in making a diagnosis as in solving their problem - having a child!
For patients with unexplained infertility, we offer one of five the following options, depending on specific situation and wishes of patients:
Waiting strategy
Before starting treatment, it is worth reviewing the history of couples with unexplained infertility who have not attempted any treatment. For spouses with unexplained infertility who have been trying to conceive on their own for 5 years, pregnancy occurs, according to various sources, in 30%-60% of cases. In this regard, it is very important to take into account the woman’s age. If the couple is still young, they should take into account that over time they can overcome infertility on their own without resorting to treatment. For a woman over 35, this is most likely unacceptable, since her chances of becoming pregnant decrease significantly with each passing month. In addition, the duration of infertility affects the likelihood of pregnancy. The longer infertility continues, the less chance of spontaneous pregnancy. After five years of unexplained infertility, the chance of conceiving on your own is no more than 10%.
The waiting strategy is acceptable for some married couples under 30 years of age, but, as practice shows, most spouses refuse it. You must remember that after 35 years, the quality of a woman’s eggs constantly deteriorates, the number of genetic defects in them increases, so there is no time to waste if you are already over 30.
Intrauterine insemination (IUI)
Injecting sperm into the uterus has been used as a method of treating infertility for over 100 years. IUI is also used as an empirical treatment for couples with unexplained infertility. It can be assumed that the likelihood of pregnancy will increase if a large number of motile sperm are introduced into the uterine cavity at the right time. Although this argument seems quite reasonable, based on a review of the literature and own experience, it can be argued that IUI without ovulation stimulation practically does not increase the chances of pregnancy in couples with unexplained infertility. The effectiveness of IUI in this case is approximately 10 times lower than the effectiveness of IVF. Clomiphene citrate and IUI (CC/IUI)
Empirical treatment with clomiphene citrate (Clomid, Clostilbegit) is based on the assumption that increasing the number of eggs capable of fertilization in a given cycle can increase the likelihood that at least one mature egg will lead to pregnancy. normal pregnancy. It is possible that this treatment will randomly correct minor problems with ovulation, low fertilization rates, or poor egg quality.
Most researchers conclude that for couples with unexplained infertility, the use of clomiphene citrate (alone or in combination with IUI) almost doubles the likelihood of pregnancy in each treatment cycle, although this therapy is less effective than IVF.
HMG/IUI or FSH /VMI
Empirical therapy with gonadotropin injections in combination with IUI is based on the same assumption as the treatment of CC/IUI. Gonadotropic drugs have a much more pronounced effect than clomiphene citrate, and almost triple the chances of pregnancy, but at the same time lead to high frequency multiple pregnancies (twins and more fetuses). Due to this this method treatment should be used with great caution. Moreover, in the USA, in order to reduce the frequency of multiple pregnancies during IUI with hormonal stimulation, a standard has been developed that prohibits IUI in the presence of more than 3 follicles larger than 18 mm.
In vitro fertilization ( ECO )
IVF includes:
With in vitro fertilization, it is possible to adjust the treatment regimen and apply various technologies if there were problems with fertilization in previous IVF cycles or there is reason to suspect them. In cases where fertilization does not occur or occurs in a small percentage of cases, it is possible to inject sperm directly into the egg using microinstruments (ICSI), thus eliminating the question of lack of fertilization as a cause of infertility. In cases where outer shell the eggs are too thick or dense, special microsurgical procedures are performed in the laboratory to overcome this pathology - assisted hatching. If the embryos grow slowly, or stop developing at some stage, this will be detected in the laboratory and other options for further treatment will be suggested.
Analyzing the world literature on IVF in cases of unexplained infertility, we can conclude that IVF gives these patients a very high chance of achieving pregnancy (from 20% to 70% depending on the woman’s age), while at the same time allowing to identify specific cellular and genetic pathologies leading to infertility in a given couple. The reason IVF is a very effective treatment for patients with unexplained infertility is that it bypasses many of the barriers to sperm and egg that exist in the human body, even if it is not possible to accurate diagnosis and name these barriers.
Idiopathic infertility (infertility of unknown origin) affects an average of 20% of couples seeking to become parents. It is possible to get rid of the disease if it is done in time.
Infertility of unknown etiology is diagnosed when all necessary research passed, but the results are within normal limits. There are also no infections or genetic pathologies, everything is fine, but it is not possible to get pregnant.
Idiopathic infertility occurs due to for unknown reasons. The woman and man are healthy, but they are unable to conceive a child.
In this case, you should wait, because the lack of pregnancy may be due to psychological reasons. To confirm the diagnosis of psychological infertility, it is worth visiting a psychologist, in the absence of others visible reasons impossibility of conception.
Often a woman or a man has deviations, but it is not possible to identify which ones exactly for a number of reasons, in particular, because this has not been studied by reproductive specialists.
The diagnosis of unknown origin is made when a woman does not become pregnant for more than a year of active sexual activity. All tests are in good condition.
Suggests that in the work of endocrine and genitourinary system there are no glitches.
Menstruation is regular, ovulation occurs in every cycle. The fallopian tubes are passable, there are no adhesions in the pelvis. There are also no fibroids, endometriosis, polyps, or endometrial hyperplasia. The cervix was normal after examination.
The presence of sexually transmitted diseases is negative, there is no antigenic conflict, as well as genetic diseases. Then the woman is diagnosed with unspecified infertility (female/male), and a number of additional examinations are prescribed.
In order for a couple to be diagnosed, the partner must also be tested. He needs to do an analysis - a spermogram (to assess the quality of sperm) and a blood test for antibodies.
When no abnormalities in the functioning of the female genital organs are detected, the specialist prescribes additional studies. These include:
If these indicators deviate from the norm, doctors prescribe certain therapy and correct the condition.
To find out the factors, you should take some tests, in particular:
To make a correct diagnosis and rule out everything possible problems, it is worth going through several doctors:
A man must also pass everyone necessary doctors, including a urologist, to rule out possible problems.
Unexplained infertility is treated using the following procedures:
Insemination is a procedure during which a specialist is a “conductor” of male sperm, he “delivers” it to the fallopian tubes. The doctor injects sperm directly into the woman's genitals. The method increases the likelihood of conception.
Another method is . A woman takes medications that help ripen not just one follicle, but several at once. This is called superovulation. After this, the woman is injected with sperm, performing insemination, or the couple uses traditional way conception - sexual intercourse.
To carry out IVF, the embryo is grown in a special environment in a test tube, after which it is placed in the uterus.
There is evidence that the purpose folic acid increases the percentage of pregnancies in women with folate cycle defects.
If conception does not occur naturally within 1.5 years of treatment, the doctor insists on performing IVF. This is the method that allows you to cope with the disease.
IVF is an expensive procedure, but today it is included in the list of available services for compulsory medical insurance policy(compulsory health insurance).
Infertility is a common problem among both men and women. When treating infertility, it is important to eliminate its cause. That is why infertility of unknown origin, also called idiopathic infertility, due to the lack of specific causes, is difficult to treat.
At the beginning of the 20th century, there were much more cases of diagnosing causeless infertility than today. This is due to the fact that at present quite a lot of diagnostic methods have been developed, therefore, many more cases of infertility can be explained and subsequently treated. Moreover, more and more new causes are being discovered, which has made the diagnosis of “unexplained infertility” a rarity.
This diagnosis is made if two healthy partners have regular sexual intercourse long time cannot conceive a child. Doctors do not rule out simple bad luck as the cause. In most cases, infertility of unknown origin is explained by genetic incompatibility of partners, but this problem has been little studied at the moment.
It is impossible to speak definitely about the causes of idiopathic infertility, since its name speaks for itself: clear reasons there is no such infertility. Whether infertility is considered causeless is determined by information about the health status of the partners and the period of time during which attempts were made to conceive a child. If no obstacles to conception are observed and it does not occur for such a long period that it is impossible to explain the failure by bad luck or coincidence of circumstances, we can only talk about infertility of unknown origin.
It can be difficult to track down the reasons why conception does not occur. This is due to the fact that for conception it is necessary coordinated work physiological and hormonal processes, and if at least one of them goes wrong, pregnancy may not occur. Diagnosing such cases is quite difficult, and in this situation doctors diagnose “idiopathic infertility.”
The main difficulty in treating idiopathic infertility is due to the fact that the causes that need to be eliminated are unknown. But medicine is in a state of constant development, so cases of causeless infertility are becoming less and less common. This is hope for women who cannot get pregnant for unknown reasons.
Currently, the following potential causes of idiopathic infertility are identified::
Medical statistics have evidence that absolutely healthy partners who were unable to conceive a child successfully do so with other partners in the future. One of the indirect evidence genetic incompatibility IVF procedures become unsuccessful.
It is impossible to judge the causes of unexplained infertility partly due to the fact that there are no specific symptoms and signs. Results of studies, analyzes and others diagnostic measures no pathologies are detected. And there is only one symptom of infertility of unknown origin - lack of pregnancy.
It is only possible to understand that there are some deviations based on available statistical data. If, after two years of constant attempts to conceive and a stable sex life, there is no pregnancy, we can confidently talk about causeless infertility. If you have been unable to conceive a child for a year, it is too early to think about this diagnosis: this is only a reason to undergo a detailed examination by a gynecologist and reproductive specialist.
Diagnosis of infertility of unknown origin comes down to excluding well-known causes that can be eliminated with targeted treatment. To diagnose infertility, the following examinations are necessary:
Problems with conception are most often caused by poor condition health, and they must be excluded first.
Performed to assess sperm motility in the cervix.
Antisperm antibodies contained in a woman’s blood interfere with the conception of a child.
If there is no ovulation, conception cannot occur.
If they are detected, it will be enough to simply be cured.
If not working correctly endocrine system the hormonal processes necessary for conception do not occur.
Identifies possible mechanical barriers to conception - for example, anomalies in the structure of the reproductive organs.
It is prescribed to exclude endometriosis and other endometrial pathologies that interfere with successful conception.
In some cases, conception may not occur due to the presence of genetic diseases and genetic incompatibility of the spouses.
Infertility is recognized as causeless if the above studies did not reveal any abnormalities or pathologies.
Treatment for this diagnosis is difficult, but possible, and even with a positive result. In case of infertility of unknown origin, the doctor seeks to exclude even the most minor pathologies that normally do not interfere with conception. For causeless infertility they are used following methods treatment:
In case of infertility of unknown origin, surgical dissection of adhesions and cleaning of tubes are carried out even if there are no direct indications. The slightest adhesions or minor obstruction, as well as other abnormalities, are eliminated using laser and other surgical methods.
Partly surgical procedure can be called IVF (in vitro fertilization). In this case, seminal fluid is delivered to the uterus using medical instruments. If IVF helps you get pregnant, you can judge that sperm do not penetrate the egg during the natural process.
For infertility of unknown origin, drug treatment is carried out according to a scheme similar to that for ordinary infertility. Use all types at once drug treatment Infertility is impossible, so here the responsibility falls entirely on the doctor.
For example, lack pathogenic flora and other signs of sexually transmitted infections does not mean that they do not exist. Therefore, appropriate therapy can be prescribed aimed at treating hidden diseases.
But most often it is carried out hormone therapy, which is most effective in increasing the opportunity successful conception. Hormonal therapy has a beneficial effect on the condition of the endometrium, which contributes to the successful attachment of the embryo to it.
Also to drug therapy include stimulation of superovulation, which is prescribed before IVF for successful conception. IN in this case hormone therapy creates heavy load on the woman’s body, therefore it is considered a last resort. Actually, in vitro fertilization itself is the last chance to conceive a child for those who cannot do this naturally.
This is the most common treatment method, which involves the use of a complex of drugs containing hormones, vitamins and helping to strengthen the immune system. Complex therapy has an effect on all body systems and significantly increases the chances of conception.
During combination therapy, it is strongly recommended to monitor ovulation and continue trying to conceive.
Like any alternative medicine, traditional treatment not the most effective way. By itself, such treatment is not capable of bringing positive results, but can increase the effectiveness of other methods if you strictly follow your doctor's recommendations. Another reason you should discuss this therapy with your doctor is that traditional methods have their own contraindications - for example, in case of individual intolerance to the components, they are even harmful.
IN folk medicine Viburnum and sea buckthorn juice and plantain decoctions are used. They can be used in combination with the above treatment methods in the absence of contraindications.
The results of treatment for unexplained infertility largely depend on the doctor’s qualifications, so the issue of choosing a clinic or reproduction center is especially important.
Unexplained infertility, otherwise known as idiopathic or unexplained infertility, means that after extensive examination of the man and woman, the cause of the infertility has not been found. This diagnosis is made by exclusion - that is, only after all the necessary examinations have been carried out and their results are normal.
The diagnosis of “idiopathic infertility” can only be made if the following conditions are present:
This diagnosis cannot be made unless the woman has had a diagnostic laparoscopy because some causes of infertility, such as endometriosis, can only be diagnosed during surgery.
[*]for a man:
[*]Sexual intercourse occurs quite often, especially during the period of ovulation, and spouses try to conceive for at least a year.
Patients diagnosed with unexplained infertility can be divided into two groups. The first group does not have any problems with fertility, they are simply “unlucky yet.” The second group actually has an objective cause of infertility, but it cannot be identified by modern diagnostic methods, or it is still unknown to scientists. The diagnosis of “unexplained infertility” is a recognition of the imperfection of the diagnostic capabilities of modern medicine. Just 30-40 years ago, the diagnosis of “idiopathic infertility” was given to approximately half of married couples. As diagnostic techniques have developed, this number has steadily declined and is now around 10%.
In reality, there may be hundreds or even thousands of possible causes of infertility because many events must happen in perfect sequence for conception to occur, and the child was born. In simplified form it looks like this:
If this chain is broken in any of the links, it will lead to the impossibility of conception.
The above model is extremely simplified, but we think the general meaning is clear to you. Literally hundreds of molecular and biochemical events and transformations must occur in a timely manner for pregnancy to occur. A standard examination for infertility touches on these mechanisms very superficially, trying to identify only the most severe and obvious pathologies, such as blocked fallopian tubes, reduced sperm count, irregular ovulation, etc. This examination practically does not affect events occurring at the molecular level. Apparently this is a matter of the future.
1. What is the problem if everything is fine?
Infertility is surrounded by a huge amount of assumptions, myths, hopes and fears. An almost endless list of factors is cited as reasons that influence fertility in one way or another. They include almost every aspect of life, from diet, lifestyle and environmental influences to thoughts and psychological state. There is probably not a single area in the body of a woman or a man, in their minds, lifestyle and relationships that is not suspected as a possible cause of infertility.
Most of these assumptions have not been thoroughly tested. Some substances or activities are included in the list of potential "causes" of infertility only because they are more common in people with infertility than in other people. However, infertility itself is quite common, which means that a very large number of observations are required to establish a possible connection, because people can have a lot in common beyond infertility simply by coincidence.
A diagnosis of unexplained infertility implies that there is something wrong with the gametes (egg and sperm), their interaction with each other, or their interaction with the woman's reproductive system. In short, in the case of unexplained infertility, we can assume that the sperm, although looking absolutely normal under the microscope, are not performing their function (fertilization). We are not sure that the fertilized egg (zygote, embryo) divides normally and has no pathologies. We are not sure that the membrane of the egg (zona pellucida) is not too thick or dense, preventing the embryo from breaking it and coming out.
Unexplained infertility means that there is a problem in the process of conception that we cannot detect unless we do in vitro fertilization (we obtain eggs from the ovary and see problems with fertilization, embryo division and membrane thickness directly in the laboratory). At the same time, in vitro fertilization does not always help determine the cause of infertility, although it gives spouses the opportunity to have a child with a very high probability.
2. What can be done to help patients with unexplained infertility?
Most patients worry that because we can't find the cause of their infertility, we won't be able to help them get pregnant through IVF. Fortunately, today this is not the case, because our technologies in overcoming infertility are significantly superior to those in diagnosing its causes. In the end, most infertile couples are interested not so much in making a diagnosis as in solving their problem - having a child!
For patients with unexplained infertility, we offer one of the following five options, depending on the specific situation and the wishes of the patients:
Waiting strategy
Before starting treatment, it is worth reviewing the history of couples with unexplained infertility who have not attempted any treatment. For spouses with unexplained infertility who have been trying to conceive on their own for 5 years, pregnancy occurs, according to various sources, in 30%-60% of cases. In this regard, it is very important to take into account the woman’s age. If the couple is still young, they should take into account that over time they can overcome infertility on their own without resorting to treatment. For a woman over 35, this is most likely unacceptable, since her chances of becoming pregnant decrease significantly with each passing month. In addition, the duration of infertility affects the likelihood of pregnancy. The longer infertility continues, the less chance of spontaneous pregnancy. After five years of unexplained infertility, the chance of conceiving on your own is no more than 10%.
The waiting strategy is acceptable for some married couples under 30 years of age, but, as practice shows, most spouses refuse it. You must remember that after 35 years, the quality of a woman’s eggs constantly deteriorates, the number of genetic defects in them increases, so there is no time to waste if you are already over 30.
Intrauterine insemination (IUI)
Injecting sperm into the uterus has been used as a method of treating infertility for over 100 years. IUI is also used as an empirical treatment for couples with unexplained infertility. It can be assumed that the likelihood of pregnancy will increase if a large number of motile sperm are introduced into the uterine cavity at the right time. Although this argument seems quite reasonable, based on a review of the literature and our own experience, it can be argued that IUI without ovulation stimulation practically does not increase the chances of pregnancy in couples with unexplained infertility. The effectiveness of IUI in this case is approximately 10 times lower than the effectiveness of IVF. Clomiphene citrate and IUI (CC/IUI)
Empirical treatment with clomiphene citrate (Clomid, Clostilbegit) is based on the assumption that increasing the number of eggs that can be fertilized in a given cycle can increase the likelihood that at least one mature egg will lead to a normal pregnancy. It is possible that this treatment will randomly correct minor problems with ovulation, low fertilization rates, or poor egg quality.
Most researchers conclude that for couples with unexplained infertility, the use of clomiphene citrate (alone or in combination with IUI) almost doubles the likelihood of pregnancy in each treatment cycle, although this therapy is less effective than IVF.
HMG/IUI or FSH /VMI
Empirical therapy with gonadotropin injections in combination with IUI is based on the same assumption as the treatment of CC/IUI. Gonadotropic drugs have a much more pronounced effect than clomiphene citrate, and almost triple the chances of pregnancy, but at the same time lead to a high frequency of multiple pregnancies (twins or more). In this regard, this treatment method should be used with great caution. Moreover, in the USA, in order to reduce the frequency of multiple pregnancies during IUI with hormonal stimulation, a standard has been developed that prohibits IUI in the presence of more than 3 follicles larger than 18 mm.
In vitro fertilization ( ECO )
IVF includes:
With in vitro fertilization, it is possible to adjust the treatment regimen and apply various technologies if there were problems with fertilization in previous IVF cycles or there is reason to suspect them. In cases where fertilization does not occur or occurs in a small percentage of cases, it is possible to inject sperm directly into the egg using microinstruments (ICSI), thus eliminating the question of lack of fertilization as a cause of infertility. In cases where the outer shell of the egg is too thick or dense, special microsurgical procedures are performed in the laboratory to overcome this pathology - assisted hatching. If the embryos grow slowly, or stop developing at some stage, this will be detected in the laboratory and other options for further treatment will be suggested.
Analyzing the world literature on IVF in cases of unexplained infertility, we can conclude that IVF gives these patients a very high chance of achieving pregnancy (from 20% to 70% depending on the woman’s age), while at the same time allowing the identification of specific cellular and genetic pathologies that led to infertility in a given couple. The reason IVF is a very effective treatment for patients with unexplained infertility is that it bypasses many of the barriers to sperm and egg production that exist in the human body, even if it is impossible to accurately diagnose and name these barriers.
