Açıklanamayan İnfertilitede İlk Tedavi İUİ olmalıdır

Açıklanamayan İnfertilitede İlk Tedavi İUİ olmalıdır
14 Nisan 2013 Prof.Dr.Sezai ŞAHMAY İ.Ü.Cerrahpaşa Tıp Fakültesi Kadın hastalıkları ve Doğum ABD Üreme Endokrinolojisi ve İnfertilite Bilim Dalı

Gonadotropin indüksiyonu + İUİ meta analiz (n.4154 siklus)
% gebelik/siklus Peterson CM et al:Fertil Steril 62:535, 1994

Açıklanamayan İnfertilitede İUİ
Spontan siklus + Koit / İUİ Veltman-Verhulst SM, Cohlen BJ, Hughes E, Heineman MJ SM Cocchrane 2012

Ovülasyon indüksiyonu + Koit / İUİ Veltman-Verhulst SM, Cohlen BJ, Hughes E, Heineman MJ SM Cocchrane 2012

İUİ + Spontan siklus / Ovİnd Veltman-Verhulst SM, Cohlen BJ, Hughes E, Heineman MJ SM Cocchrane 2012

İUİ+Ovİnd / İVF Among treatment-naive women there was no significant difference between the groups in LBR, but in pretreated women there was a significantly higher LBR in those who underwent IVF compared to IUI+SO (OR 2.66, 95% CI 1.94 to 3.63) (Analysis 3.1; Figure 5). Pandian Z, Gibreel A, Bhattacharya S Cocchrane 2012

Açıklanamayan İnfertilitede Takip-İUİ-İVF
Long-term outcome in couples with unexplained subfertility and an intermediate prognosis initially randomized between expectant management and immediate treatment Inge M. Custers1,*, Minouche M.E. van Rumste2, JanWillem van der Steeg1, Madelon vanWely1, Peter G.A. Hompes3, Patrick Bossuyt4, Frank J. Broekmans5, Cees N.M. Renckens6, Marinus J.C. Eijkemans7, Thierry J.H.M. van Dessel8, Fulco van der Veen1, Ben W.J. Mol2, Pieternel Steures1, and CECERM9 Human Reproduction, Vol.27, No.2 pp. 444–450, 2012 In the EM group 364 IUI cycles were started which resulted in 24 ongoing pregnancies (6.6% per started cycle). In the immediate treatment group 661 IUI cycles were started, resulting in 35 ongoing pregnancies (5.3% per started cycle). In the EM group 75 IVF cycles were started resulting in 21 ongoing pregnancies (28% per started IVF cycle) versus 108 IVF cycles in the immediate treatment group resulting in 32 ongoing pregnancies (30% per started cycle) (Table III). background: We recently reported that treatment with intrauterine insemination and controlled ovarian stimulation (IUI-COS) did not increase ongoing pregnancy rates compared with expectant management (EM) in couples with unexplained subfertility and intermediate prognosis of natural conception. Long-term cost-effectiveness of a policy of initial EM is unknown. We investigated whether the recommendation not to treat during the first 6 months is valid, regarding the long-term effectiveness and cumulative costs. methods: Couples with unexplained subfertility and intermediate prognosis of natural conception (n ¼ 253, at 26 public clinics, the Netherlands) were randomly allocated to 6 months EM or immediate start with IUI-COS. The couples were then treated according to local protocol, usually IUI-COS followed by IVF. We followed couples until 3 years after randomization and registered pregnancies and resources used. Primary outcome was time to ongoing pregnancy. Secondary outcome was treatment costs. Analysis was by intentionto- treat. Economic evaluation was performed from the perspective of the health care institution. results: Time to ongoing pregnancy did not differ between groups (log-rank test P ¼ 0.98). Cumulative ongoing pregnancy rates were 72–73% for EM and IUI-COS groups, respectively [relative risk 0.99 (95% confidence interval (CI) 0.85–1.1)]. Estimated mean costs per couple were E3424 (95% CI E880–E5968) in the EM group and E6040 (95% CI E4055–E8125) in the IUI-COS group resulting in an estimated saving of E2616 per couple (95% CI E385–E4847) in favour of EM. conclusions: In couples with unexplained subfertility and an intermediate prognosis of natural conception, initial EM for 6 months results in a considerable cost-saving with no delay in achieving pregnancy or jeopardizing the chance of pregnancy. Further comparisons between aggressive and milder forms of ovarian stimulation should be performed. Custers IM et al.:Human Reprod, 27:444, 2012

Açıklanamayan İnfertilitede Takip-İUİ
Gebeliğe erişim süresi Custers IM et al.:Human Reprod, 27:444, 2012

İVF (tek embriyo transferi) ve İUİ+OI (3 siklus)
Couples with unexplained subfertility and unfavorable prognosis: a randomized pilot trial comparing the effectiveness of in vitro fertilization with elective single embryo transfer versus intrauterine insemination with controlled ovarian stimulation Inge M. Custers, M.D.,a Tamar E. K€onig, M.D.,b Frank J. Broekmans, M.D., Ph.D.,c Peter G. A. Hompes, Prof.,b Eugenie Kaaijk, M.D., Ph.D.,d Jur Oosterhuis, M.D., Ph.D.,e Monique H. Mochtar, M.D.,a Sjoerd Repping, Prof.,a Madelon van Wely, Ph.D.,a Pieternel Steures, M.D., Ph.D.,a Fulco van der Veen, Prof.,a and Ben W. J. Mol, Prof.a,f Objective: To evaluate the effectiveness of IVF with elective single embryo transfer (IVF-eSET) vs. IUI with controlled ovarian stimulation (IUI-COS) as an alternative treatment to reduce the risk for a multiple pregnancy. Design: Randomized pilot trial. Setting: Three academic and six teaching hospitals in the Netherlands. Patient(s): Couples with unexplained or mild male subfertility and an unfavorable prognosis for natural conception. Intervention(s): One cycle of IVF-eSET or three cycles of IUI-COS. Main Outcome Measure(s): Ongoing pregnancy per couple. Result(s): We randomly allocated 116 women to IVF-eSET (n ¼ 58) or IUI-COH (n ¼ 58). There were 14 ongoing pregnancies (24%) in the IVF-eSET group and 12 pregnancies (21%) in the IUI-COS group (relative ratio 1.17; 95% confidence interval 0.60–2.30). There were two twin pregnancies in the IVF-eSET group (14%) and two twin pregnancies and one triplet pregnancy in the IUI-COH group (25%). Conclusion(s): In patients with unexplained or mild male subfertility and a poor prognosis for natural conception, one cycle of IVF-eSET might be as effective as three cycles of IUI-COS as primary treatment. Elective single embryo transfer does not seem an effective strategy in preventing multiple pregnancies in this particular population. In the future a strict SET policy (i.e., compulsory SET) might be an option. Our trial provides evidence for the feasibility and highlights the importance of a large definitive trial to determine the effectiveness and side effects of both strategies. (Fertil Steril 2011;96:1107– by American Society for Reproductive Medicine.) Custers IM et al.:Fertil Steril 96:1107, 2011

Açıklanamayan İnfertilitede kümülatif gebelik oranları
Unexplained infertility: overall ongoing pregnancy rate and mode of conception M.Brandes1,*, C.J.C.M.Hamilton1, J.O.M.van der Steen1, J.P.de Bruin1, R.S.G.M. Bots2,W.L.D.M. Nelen3, and J.A.M. Kremer3 Human Reproduction, Vol.26, No.2 pp. 360–368, 2011 Figure 2 Cumulative ongoing pregnancy curve for the total cohort unexplained infertility (n ¼ 437) with special attention for the contribution per mode of conception. Note: these curves are an exact representation of the cumulative OPRs, not Kaplan–Meier curves. IUI, intrauterine insemination; IVF, in vitro fertilization, including IVF, ICSI, frozen embryo transfer and Oocyte donation. background: Unexplained infertility is one of the most common diagnoses in fertility care. The aim of this study was to evaluate the outcome of current fertility management in unexplained infertility. methods: In an observational, longitudinal, multicentre cohort study, 437 couples were diagnosed with unexplained infertility and were available for analysis. They were treated according to their prognosis using standing national treatment protocols: (i) expectant management– IUI–IVF (main treatment route), (ii) IUI–IVF and (iii) directly IVF. Primary outcome measures were: ongoing pregnancy rate, patient flow over the strategies, numbers of protocol violation and drop out rates. A secondary outcome measure was the prediction of ongoing pregnancy and mode of conception. results: Of all couples 81.5% (356/437) achieved an ongoing pregnancy and 73.9% (263/356) of the pregnancies were conceived spontaneously. There were 408 couples (93.4%) in strategy-1, 21 (5.0%) in strategy-2 and 8 (1.8%) in strategy-3. In total, 33 (7.6%) couples entered the wrong strategy. There were 104 couples (23.8%) who discontinued fertility treatment prematurely: 26 on doctor’s advice (with 4 still becoming pregnant) and 78 on their own initiative (with 33 still achieving a pregnancy). Predictors for overall pregnancy chance and mode of conception were duration of infertility, female age and obstetrical history. conclusions: Overall success rate in couples with unexplained infertility is high. Most pregnancies are conceived spontaneously. We recommend that if the pregnancy prognosis is good, expectant management should be suggested. The prognosis criteria for treatment with IUI or IVF needs to be investigated in randomized controlled trials. Brandes M et al.: Human Reproduction, 26:360, 2011

Bir siklus İUİ+Oİ ve İVF maliyeti
Long-term outcome in couples with unexplained subfertility and an intermediate prognosis initially randomized between expectant management and immediate treatment Inge M. Custers1,*, Minouche M.E. van Rumste2, JanWillem van der Steeg1, Madelon vanWely1, Peter G.A. Hompes3, Patrick Bossuyt4, Frank J. Broekmans5, Cees N.M. Renckens6, Marinus J.C. Eijkemans7, Thierry J.H.M. van Dessel8, Fulco van der Veen1, Ben W.J. Mol2, Pieternel Steures1, and CECERM9 Human Reproduction, Vol.27, No.2 pp. 444–450, 2012 background: We recently reported that treatment with intrauterine insemination and controlled ovarian stimulation (IUI-COS) did not increase ongoing pregnancy rates compared with expectant management (EM) in couples with unexplained subfertility and intermediate prognosis of natural conception. Long-term cost-effectiveness of a policy of initial EM is unknown. We investigated whether the recommendation not to treat during the first 6 months is valid, regarding the long-term effectiveness and cumulative costs. methods: Couples with unexplained subfertility and intermediate prognosis of natural conception (n ¼ 253, at 26 public clinics, the Netherlands) were randomly allocated to 6 months EM or immediate start with IUI-COS. The couples were then treated according to local protocol, usually IUI-COS followed by IVF. We followed couples until 3 years after randomization and registered pregnancies and resources used. Primary outcome was time to ongoing pregnancy. Secondary outcome was treatment costs. Analysis was by intentionto- treat. Economic evaluation was performed from the perspective of the health care institution. results: Time to ongoing pregnancy did not differ between groups (log-rank test P ¼ 0.98). Cumulative ongoing pregnancy rates were 72–73% for EM and IUI-COS groups, respectively [relative risk 0.99 (95% confidence interval (CI) 0.85–1.1)]. Estimated mean costs per couple were E3424 (95% CI E880–E5968) in the EM group and E6040 (95% CI E4055–E8125) in the IUI-COS group resulting in an estimated saving of E2616 per couple (95% CI E385–E4847) in favour of EM. conclusions: In couples with unexplained subfertility and an intermediate prognosis of natural conception, initial EM for 6 months results in a considerable cost-saving with no delay in achieving pregnancy or jeopardizing the chance of pregnancy. Further comparisons between aggressive and milder forms of ovarian stimulation should be performed. Custers IM et al.:Human Reprod, 27:444, 2012

Nedeni Açıklanamayan İnfertilitelerde İUİ’nin değeri ve Maliyet (45 çalışmanın retrospektif analizi)
10.000$ 17.000$ 10.99 50.000$ Geb/siklus Guzick DS et al:Fertil Steril 70:207, 1998

TMS>106 İUİ cost-efektif’dir siklus n.3,479
Fertil Steril Apr;75(4):661-8 Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Van Voorhis BJ, Barnett M, Sparks AE, Syrop CH, Rosenthal G, Dawson J. Department of Obstetrics & Gynecology, University of Iowa College of Medicine, Iowa, Iowa City , USA. OBJECTIVE: To determine prognostic factors for achieving a pregnancy with intrauterine insemination (IUI) and IVF. To compare the effectiveness and cost-effectiveness of IUI and IVF based on semen analysis results. DESIGN: Retrospective cohort study. SETTING: Academic university hospital-based infertility center. PATIENT(S): One thousand thirty-nine infertile couples undergoing 3,479 IUI cycles. Four hundred twenty-four infertile couples undergoing 551 IVF cycles.Intervention(s): IUI and IVF treatment. MAIN OUTCOME MEASURE(S): Multiple logistic regression analysis was used to assess the significance of prognostic factors including a woman's age, gravidity, duration of infertility, diagnoses, use of ovulation induction, and sperm parameters for predicting the outcomes of clinical pregnancy and live birth rate after the first cycle of IUI and IVF. The relative effectiveness and cost-effectiveness of these treatments were then determined based on sperm count results. RESULT(S): Female age, gravidity, and use of ovulation induction were all independent factors in predicting pregnancy after IUI. The average total motile sperm count in the ejaculate was also an important factor, with a threshold value of 10 million. For IVF, only female age was an important predictor for both clinical and ongoing pregnancy. When the average total motile sperm count was under 10 million, IVF with ICSI was more cost-effective than IUI in our clinic. CONCLUSION(S): An average total motile sperm count of 10 million may be a useful threshold value for decisions about treating a couple with IUI or IVF. PMID: [PubMed - indexed for MEDLINE] $/Doğum Van Voorhis BJ et al.:Fertil Steril 75:661, 2001

Maliyet Hesabı Is in vitro fertilisation more effective than stimulated intrauterine insemination as a first-line therapy for subfertility? A cohort analysis Georgina M. CHAMBERS,1 Elizabeth A. SULLIVAN,1 Marian SHANAHAN,2 Maria T. HO,3 Katelyn PRIESTER1 and Michael G. CHAPMAN1,4,5 Objective: To compare a strategy of two cycles of intrauterine insemination with controlled ovarian hyperstimulation (IUI ⁄COH) vs one in vitro fertilisation (IVF) treatment programme (one fresh plus associated frozen embryo cycles) in couples presenting with unexplained, mild male or mild female subfertility. Methods: A retrospective cohort design was used and analysed according to intention-to-treat principles. A total of 272 couples underwent an intended course of two cycles of IUI ⁄COH and 176 couples underwent one IVF treatment programme. Results: The cumulative live birth rate (CLBR) per couple for the IUI ⁄COH group was 27.6% compared to 39.2% for the IVF group (P = 0.01). The mean time to pregnancy was 69 days in the IUI ⁄COH group compared to 44 days in the IVF group (P = 0.02). The IVF programme was costlier, with an incremental cost-effectiveness ratio for an additional live birth in the range of $39 637–$ The multiple delivery rate was 13.3% in the IUI ⁄COH group compared to 10.1% in the IVF group (P = 0.55). One set of triplets and one set of quadruplets followed IUI ⁄COH treatment. Conclusions: One IVF treatment programme was more effective, but costlier than an intended course of two cycles of IUI ⁄COH. With consistently higher success rates, shorter times to pregnancy and a trend to less higher order multiple pregnancies, this study supports the view that IVF is now potentially safer and more clinically effective than IUI ⁄COH as a first-line therapy for subfertility. The results of the cost-effectiveness analysis for the intention-to-treat and pre-protocol analysis are presented in Table 5. Regardless of the perspective taken in analysing the data or the definition of costs used, no strategies were clearly dominated by the other in all analyses; that is, IVF was not only the most expensive option but was also the most effective. From an intention-to-treat perspective, the average cost per live birth for the IUI ⁄COH group was $12 153 compared to $ for the IVF group. Taking into account the indirect costs associated with complications and multiple births, the average cost per live birth rose by 112% to $ for the IUI ⁄COH group and by 52% to $31 039 for the IVF group, reflecting the higher multiple birth rate in the IUI⁄COH group, in particular, the birth of one set of triplets and one set of quadruplets. From a per-protocol perspective, the average cost per live birth in the IUI ⁄COH group was $10 792, increasing by 130% to $ when indirect costs were included. Depending on the approach taken to analyse the data, the ICER (the difference in the cost and effect of one strategy from the cost and effect of the other) ranged from $ to $ per extra live birth implicit in a decision to treat with IVF.--- Definition The incremental cost-effectiveness ratio (ICER) is an equation used commonly in health economics to provide a practical approach to decision making regarding health interventions. It is typically used in cost-effectiveness analysis. ICER is the ratio of the change in costs to incremental benefits of a therapeutic intervention or treatment.[1] The equation for ICER is: ICER = (C1 – C2) / (E1 – E2) where C1 and E1 are the cost and effect in the intervention or treatment group and where C2 and E2 are the cost and effect in the control care group.[2] Costs are usually described in monetary units while benefits/effect in health status is measured in terms of quality-adjusted life years (QALYs) gained or lost.[3] Benefits of Using ICER ICER provides a means of comparing projects or interventions across various disease states and treatments. As seen in the equation above, a ratio is created with the units of cost per benefits/effect unit. By using this ratio, comparisons can be made between treatment modalities to determine which provides a more cost-effective therapy. ICER studies thus provide an opportunity to help contain health care costs without adverse health consequences.[4] They also provide to policy makers information on where resources should be allocated when they are limited.[5] As health care costs have continued to rise, many new clinical trials are attempting to integrate ICER into results to provide more evidence of potential benefit.[6] Controversies of Using ICER Many people feel that basing health care interventions on cost-effectiveness is a type of health care rationing and have expressed concern that using ICER will limit the amount or types of treatments and interventions available to patients.[5] Currently, the National Institute for Health and Clinical Excellence (NICE) of England’s National Health Service (NHS) uses cost-effectiveness studies to determine if new treatments or therapies provide better value relative to the treatment that is currently in use. With the number of cost-effectiveness studies rising, it is expected for a cost-effectiveness ratio threshold to be established for the acceptance of reimbursement or formulary listing. However, there is currently no evidence that health care systems have determined such a threshold;[7] without such a standard, the interpretation of ICER analyses may not be uniform. The concern that ICER may lead to rationing has affected policy makers in the United States. The Patient Protection and Affordable Care Act of 2010 provided for the creation of the independent Patient-Centered Outcomes Research Institute (PCORI). As part of its creation however, PCORI was not authorized to develop or use cost-effectiveness analysis studies. The Senate Finance Committee in writing PPACA forbade PCORI from using “dollars-per-quality adjusted life year (or similar measure that discounts the value of a life because of an individual’s disability) as a threshold to establish what type of health care is cost effective or recommended.”[8] [edit] Example If a fictional treatment costs a total of GBP 45,000 at today's value and increases a person's quality of life (QoL) from 0.5 to 0.6 for the remainder of their life from age 70 and onwards, and their expected lifespan increases from 73 to 75. The total QALYs without the treatment are: 3 years * 0.5 = 1.5 QALYs The total QALYs with the treatment are: 5 years * 0.6 = 3 QALYs So the treatment is associated with a gain of 1.5 QALYs and a cost of GBP 45,000. The ICER will then be GBP 45,000/1.5 = GBP 30,000 per QALY. Chambers GM et al.: Aus New Zeal J Obstet Gynaecol .50: 280–288,2010

Açıklanamayan İnfertilite Tedavisinde İUİ ve İVF
IVF is an accepted method of treatment for unexplained infertility. It is expensive and invasive, but it is considered as the most effective method. The average success rate for IVF treatment using fresh eggs in the UK is 28.2% for women <35, 23.6% for women aged 35–37, 18.3% for women aged 38–39 and 10.6% for women aged 40–42 (published in conjunction with the 2006–2007 Human Fertilisation Embryology Authority (HFEA, 2006–2007) guide to infertility, treatment and success, data based on treatment carried out between 1 April 2003 and 31 March 2004). Ray A et al.:RBMonline. 24:591, 2012

Açıklanamayan İnfertilite Tedavisinde Algoritma
Unexplained infertility: an update and review of practice Arpita Ray *, Amit Shah, Anil Gudi, Roy HomburgAbstract Of the couples unable to conceive without any identifiable cause, 30% are defined as having unexplained infertility. Management depends on duration of infertility and age of female partner. This review describes and comments on the definition and evidence for the management of unexplained infertility. A literature search was conducted in EMBASE, Medline, Ovid and Cochrane Database of Systematic reviews using the terms ‘infertility’, ‘unexplained infertility’, ‘idiopathic infertility’, ‘definition of infertility’, ‘treatment options’, ‘intrauterine insemination’, ‘ovulation induction’, ‘Fallopian tube sperm’, ‘GIFT’ and ‘IVF’. There is no uniform definition for unexplained infertility. This varies in the literature depending on the duration of infertility and the age of the female partner. The treatment of unexplained infertility is empirical and many different regimens have been used. Among these are expectant management, ovulation stimulation with clomiphene citrate, gonadotrophins and aromatase inhibitors, Fallopian tube sperm perfusion, tubal flushing, intrauterine insemination, gamete intra-Fallopian transfer and IVF. The standard protocol is to progress from low-technology to high-technology treatment options. On the best available evidence, an algorithm for management is suggested. There is a definite need for multicentre randomized controlled trials to identify the best treatment option in unexplained infertility using a standard definition. Spontaneous pregnancies are quite common in couples with unexplained infertility (Lenton et al., 1977; Collins and Rowe, 1989; Snick et al., 1997). A single cycle of IVF has been compared with expectant management in two trials (Hughes et al., 2004; Soliman et al., 1993). A Cochrane review (Pandian et al., 2005) on the role of IVF in unexplained infertility showed higher pregnancy rates than expectant management (OR 3.24, 95% CI 1.07–9.80). Live-birth rate/woman with a single cycle of IVF was also significantly higher than with expectant management (OR 22.0, 95% CI 2.56–189.38; Table 4; Hughes et al., 2004). Ray A et al.:RBMonline. 24:591, 2012

Açıklanamayan İnfertilite Tedavisinde Algoritma
3-6 siklus İUİ+Ovİnd İVF 2 yıl izlemek 6 siklus İUİ+Ovİnd 3 siklus İVF Unexplained infertility: overall ongoing pregnancy rate and mode of conception M.Brandes1,*, C.J.C.M.Hamilton1, J.O.M.van der Steen1, J.P.de Bruin1, R.S.G.M. Bots2,W.L.D.M. Nelen3, and J.A.M. Kremer3 Human Reproduction, Vol.26, No.2 pp. 360–368, 2011 Fertility treatment After completing the basic fertility work-up, the treatment strategy was determined according to the spontaneous pregnancy chance of the couple calculated with the models of Eimers et al. (1994) and Hunault et al. (2004). These models include the following variables: female age, infertility type, outcome of PCT, percentage of motile sperm and referral status. The cut-off point between good and poor prognosis was 30% spontaneous ongoing pregnancy chance in the following 6–12 months (Hunault et al., 2004, Steures et al., 2006). As a result of this policy the following three therapeutic strategies could be distinguished: Strategy-1 (EXP–IUI–IVF ¼ main treatment route): In case of a good prognosis (≥30%), expectant management (EXP) was recommended for up to 2 years of infertility, followed by 6 cycles COH/IUI. If no pregnancy was achieved, three cycles of IVF were recommended. If the chance of conceiving spontaneously was ,30%, fertility treatment was started and the following two strategies could be followed: Strategy-2 (IUI–IVF): If female age was ,38 years, three to six COH/IUI cycles were offered before IVF was started. Strategy-3 (direct IVF): If female age was ≥38 years, IVF was offered directly. The cut-off point of 38 years female age was based on the drop in pregnancy rate after IUI in our clinics among women older than 38 (unpublished data). For all three strategies, in case of a fertilization failure in regular IVF, the treatment was converted to ICSI in a subsequent cycle. IVF, ICSI and transfer of cryopreserved embryos will all be indicated as ‘IVF’ in this paper. background: Unexplained infertility is one of the most common diagnoses in fertility care. The aim of this study was to evaluate the outcome of current fertility management in unexplained infertility. methods: In an observational, longitudinal, multicentre cohort study, 437 couples were diagnosed with unexplained infertility and were available for analysis. They were treated according to their prognosis using standing national treatment protocols: (i) expectant management– IUI–IVF (main treatment route), (ii) IUI–IVF and (iii) directly IVF. Primary outcome measures were: ongoing pregnancy rate, patient flow over the strategies, numbers of protocol violation and drop out rates. A secondary outcome measure was the prediction of ongoing pregnancy and mode of conception. results: Of all couples 81.5% (356/437) achieved an ongoing pregnancy and 73.9% (263/356) of the pregnancies were conceived spontaneously. There were 408 couples (93.4%) in strategy-1, 21 (5.0%) in strategy-2 and 8 (1.8%) in strategy-3. In total, 33 (7.6%) couples entered the wrong strategy. There were 104 couples (23.8%) who discontinued fertility treatment prematurely: 26 on doctor’s advice (with 4 still becoming pregnant) and 78 on their own initiative (with 33 still achieving a pregnancy). Predictors for overall pregnancy chance and mode of conception were duration of infertility, female age and obstetrical history. conclusions: Overall success rate in couples with unexplained infertility is high. Most pregnancies are conceived spontaneously. We recommend that if the pregnancy prognosis is good, expectant management should be suggested. The prognosis criteria for treatment with IUI or IVF needs to be investigated in randomized controlled trials. > 38 yaş İVF Brandes M et al.: Human Reproduction, 26:360, 2011

Nedeni açıklanamayan infertilitelerde ilk tedavi İUİ mi İVF mi olmalıdır?
Sadece gebelik oranlarını değerlendirmek doğru değildir. İlk tedavi İVF olursa İUİ yok demektir. Farklı parametreler birlikte değerlendirilmelidir. - Yaş, - İnfertilite süresi, - Over reservi, - Gebeliğin oluşum süresi, Maliyet hesaplaması düşünülmelidir. Tek bir formül ile konuyu çözümlemek mümkün değildir. Tedavi önceliği çifte özelliğine göre değişebilir.

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