Efficacy Of Treatment For Unexplained Infertility

David S. Guzick , MD., Ph.D., Michael W. Sullivan, M.D., G. David Adamson, M.D., Marcelle I. Cedars, M.D., Richard J. Falk, M.D., Edwin P. Peterson, M.D., and Michael P. Steinkampf, M.D.

University of Rochester, Rochester New York; SUNY at Buffalo, Buffalo, New York; Fertility Physicians of Northern California, Palo Alto, California; University of Cincinnati, Cincinnati, Ohio, Columbia Hospital for Women, Washington, D.C.; Ann Arbor Reproductive Associates, Ypsilanti, Michigan; and University of Alabama at Birmingham, Birmingham, Alabama.

Objective:

To analyze the efficacy and cost-effectiveness of alternative treatments for unexplained infertility.

Design:

Retrospective analysis of 45 published reports.

Setting:

Clinical practices.

Patient(s):

Couples who met criteria for unexplained infertility. Women with Stage I or Stage II endometriosis were included.

Intervention(s):

Observation; clomiphene citrate (CC); gonadotropins (hMG); IUI; and GIFT and IVF.

Main outcome measure(s):

Clinical Pregnancy Rate.

Result(s):

Combined pregnancy rates per initiated cycle, adjusted for study quality, were as follows: no treatment = 1.3%-4.1%; IUI = 3.8%; CC = 5.6%; CC+IUI = 8.3%; hMG = 7.7%; hMG + IUI = 17.1%; IVF = 20.7%; GIFT = 27.0%. The estimated cost per pregnancy was $10,000 for CC + IUI, $17,000 for hMG +IUI, and $50,000 for IVF.

Conclusion(s):

Clomiphine citrate + IUI is a cost-effective treatment for unexplained infertility. If this treatment fails, hMG + IUI and assisted reproduction are efficacious therapeutic options.