Efficacy of treatment for unexplained infertility

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): Clomiphene citrate + IUI is a cost-effective treatment for unexplained infertility. If this treatment fails, hMG + IUI and assisted reproduction are efficacious therapeutic options. (Fertil Steril(R) 1998;70:207-13. (C)1998 by American Society for Reproductive Medicine.).