Featured Review: Interventions for unexplained infertility

Couples are classified as having unexplained infertility when they have tried to conceive for at least one year and no abnormality in semen analysis, ovulation, or tubal patency has been identified. Treatment options for unexplained infertility include expectant management, ovarian stimulation (OS), intrauterine insemination (IUI), OS-IUI, and in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI). Cochrane authors conductednetwork meta-analysis on interventions for unexplained infertility.Cochrane Gynecology and Fertility sat down with Dr Rui Wang, the lead author of the study, who answered their questions and shared some details about the network meta-analysis they conducted and what was found. Rui Wang is a research fellow at Department of Obstetrics and Gynaecology, Monash University. He has recently completed his PhD on the application of evidence synthesis methods in reproductive medicine at The University of Adelaide. He is a trainee scientific editor for BJOG. His research interests include evidence-based women ’s health, RCTs, and evidence synthesis methods.What was the research question?There are five commonly used treatment strategies for couples with unexplained infertility, including expectant management, ovarian stimulation (OS), intrauterine insemination (IUI), OS ‐IUI, and in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI). Among these five treatment options, which one is the most eff...
Source: Cochrane News and Events - Category: Information Technology Authors: Source Type: news

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Authors: Yang DN, Wu JH, Geng L, Cao LJ, Zhang QJ, Luo JQ, Kallen A, Hou ZH, Qian WP, Shi Y, Xia X Abstract This meta-analysis was intended to evaluate the effects of intrauterine perfusion of peripheral blood mononuclear cells (PBMC) on the pregnancy outcomes including clinical pregnancy rates, embryo implantation rates, live birth rates and miscarriage rates of infertile women who were undergoing in vitro fertilisation (IVF) treatment. By searching Pubmed, Embase database, five articles meeting the inclusion criteria were included, and 1173 women were enrolled (intrauterine PBMC group: n = 514; NO-P...
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research
Abstract A significant proportion of couples at reproductive age rely on assisted reproductive technology to overcome infertility. In vitro fertilisation (IVF) involves typically the use of exogenous gonadotropins to stimulate the ovary to produce oocytes, which are collected surgically. After fertilization by conventional IVF or intracytoplasmic sperm injection (ICSI), embryos are cultured in the embryology laboratory for a few days before being replaced into the uterus (fresh embryo transfer). Spare embryos can be vitrified and stored in liquid nitrogen to be transferred in a subsequent cycle. Over the years, co...
Source: Cryobiology - Category: Biology Authors: Tags: Cryobiology Source Type: research
CONCLUSIONS: This review evaluated different temperatures for embryo culture during IVF. There is a lack of evidence for the majority of outcomes in this review. Based on very low-quality evidence, we are uncertain if incubating at a lower temperature than 37°C improves pregnancy outcomes. More RCTs are needed for comparing different temperatures of embryo culture which require reporting of clinical outcomes as live birth, miscarriage, clinical pregnancy and adverse events. PMID: 31529804 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
In conclusion, our results showed that dual administration of G-CSF was significantly more effective that the SC only method. Impact statement What is already known on this subject? A number of studies reported the possible benefits of granulocyte colony-stimulating factor (G-CSF) administration in recurrent implantation failure (RIF) and recurrent pregnancy loss patients; however, it is unclear which administration route is better. What do the results of this study add? Our results showed that G-CSF is a promising and safe agent for increasing live birth rates in patients with RIF. Additionally, dual administration is con...
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research
CONCLUSIONS: There is insufficient evidence of differences in live birth between expectant management and the other four interventions (OS, IUI, OS-IUI, and IVF/ICSI). Compared to expectant management/IUI, OS may increase the odds of multiple pregnancy, and OS-IUI probably increases the odds of multiple pregnancy. Evidence on differences between IVF/ICSI and expectant management for multiple pregnancy is insufficient, as is evidence of a difference for moderate or severe OHSS between IVF/ICSI and OS-IUI. PMID: 31486548 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Cochrane Overviews bring together the findings from multiple reviews and one of the largest, first published in September 2013, was updated and republished in May 2018. Cindy Farquhar, from the Department of Obstetrics and Gynaecology at the University of Auckland in New Zealand describes this enormous volume of evidence for assisted reproduction." Infertility is defined as failure to conceive after one year of trying. Up to one in six couples will experience this at some point in their lives and many will seek fertility treatment in the form of assisted reproduction. When they do so, they will hope that they are gett...
Source: Cochrane News and Events - Category: Information Technology Authors: Source Type: news
This study included all women, residing in the north-east of the UK, who attended the Aberdeen Fertility Clinic and received IVF treatment between 1998 and 2011. Clinical and diagnostic information of all women was linked with treatment and pregnancy outcome data. A total of 2133 women were divided into two groups: (i) those who achieved a live birth following successful IVF or ICSI treatment (n = 1060) and (ii) those in whom treatment was unsuccessful i.e. resulted in either no pregnancy or pregnancy loss (n = 1073). The two groups were followed from the date of the last embryo transfer until the f...
Source: Human Reproduction - Category: Reproduction Medicine Source Type: research
Frank J. Broekmans* University Medical Center Utrecht, Utrecht, Netherlands The art of ovarian stimulation for IVF/ICSI treatment using exogenous FSH should be balanced against the relative contribution of other steps of the ART process such as the IVF-lab-phase and the Embryo-Transfer. The aim of ovarian stimulation is to obtain a certain number of oocytes, that will enable the best probability of achieving a live birth. It has been suggested that more oocytes will create a better prospect for pregnancy, but studies on the question whether the retrieval of a few oocytes less or more will make the difference are ...
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research
In this study, our aim was to determine which factor is more correlated with the number of oocytes retrieved in patients with endometrioma compared with controls undergoing in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI) cycles: antral follicle count (AFC) or anti-Müllerian hormone (AMH). A total of 60 women with endometrioma and a control population of 60 women without endometrioma in the same period were randomly selected underwent the injection IVF-ICSI treatment. No significant differences were found between the groups in terms of age (28.78 ± 3.49 vs. 29.52 ±&...
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research
Authors: Ashrafi M, Arabipoor A, Hemat M, Salman-Yazdi R Abstract This case-control study was designed to evaluate the impact of endometriosis and the presence of endometrioma (OMA) per se on the serum anti-Müllerian hormone (AMH) level and also to compare the in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) outcomes after therapeutic surgery in endometriosis patients, according to the localisation of endometriosis lesions. One hundred and fifty two infertile women ≤40 years with suspicious symptoms were surgically evaluated to detect the aetiology of infertility at the Royan Institut...
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research
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