Take home message
: Strategy for Management of Unexplained Infertility
A) Balanced judgment in investigations: How
useful is a test as all test are expensive and incur some mental strain too on
the couple .May add to reproductive depression. Many centres have their own
highly specialised areas of
interest and research that they then
promote as the missing cause of
unexplained infertility . Thus it
is possible to draw long lists
of putative and subtle
cause of infertility many of which cannot be proven with certainty and few of which are actually amenable to a corrective remedy that has been shown to enhance fertility
. One also should remember that couples with normal fertility can have abnormal test results. Once the well
known and obvious causes of infertility have been
excluded the treatment of couples
with unexplained infertility
should follow clear protocols.
B) Balanced judgment in formulating
therapeutic policy :- In
developing a strategy for the
management of unexplained infertility
one has to balance the efficacy of
treatment cost effectiveness
against the relative invasiveness of the various therapeutic options. Point 1:- But eye should always focus on age of
the female partner and duration of marriage. The available evidence suggests that there is little
to be gained by commencing therapy before a couple have been trying
for at least 2-3 years. Point 2: How anxious is
the couple ? However
it is difficult to enforce this guideline in practice when confronted
in the clinic by a distressed
couple with unexplained infertility . Point 3: My dear members pl do remember that a fair number of
causes of unexplained subfertility some of
these couples will have unidentified
sperm , oocyte or fertilization defects
that will only be discovered during the process
of IVF . Point 4: Why IVF first in women aged> 32
yrs bypassing IUI ?? Ans: There is logic
therefore in proceeding straight to IVF and if
fertilisation is normal and in
case first attempt is unsuccessful and no residual embryo is available at cryocan than one thing is certain that there
is no fertilization failure but disorders of implantation may be the prevailing
cause .Put under such situation , after
due counseling ART specialist can revert to either
no treatment for 1 years
have elapsed or a less invasive
treatment such as IUI with
superovulation . Bit again the age of
the female partner is the decisive factor and there is a case for treating women more than the age of 35 years more
aggressively . IVF is the most
effective way to enhance the chance of
conception and live birth and has
been increasingly used for
the management of couple
a desires and anxiety some wishing to proceed swiftly to assisted reproduction technology
and others wishing to avoid high
tech treatments for as long as
possible . It is essential to present
the couples with a realistic appraisal
of their chance of pregnancy with and
without treatment and also
to counsel them fully about the
risks and side effects of
the various therapies.
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