14A - IVF Should Be First-Line Treatment for Unexplained Infertility of Two Years Duration

Summary

Most women conceive within the first 12 months of regular unprotected sexual intercourse. Of the 16% that don’t, around half will conceive without treatment during months 12 to 24 [1]. During those first two years of trying the couple should undergo investigations including semen analysis and confirmation of ovulation and tubal patency (by HyCoSy, HSG or laparoscopy). If all tests return as normal then, by definition, the couple have ‘unexplained’ infertility. Impatience by doctor or patient to ‘do something’ can lead to the use of unnecessary interventions such as ovarian stimulation (OS) (for ovulating women?!) and/or intra-uterine insemination (IUI) (for couples with a normal reproductive tract and sperm function?!) as these are often viewed as softer, more natural treatments. But these are certainly not as natural (or as cheap) as conceiving naturally. A number of studies comparing outcomes of OS or OS-IUI versus IVF to ‘treat’ couples with unexplained infertility unfortunately include patients with 12 to 24 months of trying [2]. Unsurprisingly the OS or OS-IUI success rates are high (and therefore falsely close to IVF). I say unsurprising as the woman was likely to conceive anyway even without OS and/or IUI. For couples with less than 2 years of unexplained infertility, full investigation but no treatment is required.