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Unexplained Infertility
Pak Chung Ho (Professor)
Department of Obstetrics and Gynaecology,
University of Hong Kong,
Hong Kong
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Professor Ho is a member of the Obstetrics and Gynaecology Communications Editorial Board.
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Summary
- Unexplained infertility refers to infertility with normal results on standard investigations (i.e. clinical evaluation; semen analysis; hysterosalpingogram or laparoscopy to check tubal patency; mid-luteal serum progesterone levels).
- Expectant treatment of unexplained infertility can be adopted if the duration of infertility is less than 3 years and the woman is under 30 years of age (especially if she is parous).
- Superovulation and intrauterine insemination (IUI) is an effective form of treatment for unexplained infertility. If it fails, assisted reproduction [preferably in vitro fertilisation with embryo transfer (IVF-ET)] can be offered.
- If there is failure of fertilisation, this can be overcome with intra-cytoplasmic sperm injection (ICSI).
| Table 1. Dianostic tests for infertility |
| Correlation of results with pregnancy established |
- Semen analysis
- Tubal patency by hysterosalpingogram or laparoscopy
- Laboratory assessment of ovulation
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| Correlation not consistently established |
- Zona-free hamster egg penetration test
- Post-coital test
- Cervical mucous penetration test
- Antisperm antibody tests
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| Correlation not apparent |
- Endometrial dating
- Varicocoele assessment
- Chlamydia testinga
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Abnormal results frequently associated with subsequent fertility without therapy.
Based on available data.
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Editor's Comment
The still unsolved problem of unexplained infertility affects approximately 20% of couples. The treatment options available (reviewed here) are, of neccesity, empirical, but should be guided both by the judgement and experience of the physician, as well as by the preferences and characteristics of the patient.
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Chlamydial Infections in Infertility
Duru Shah (Professor)
Department of Obstetrics and Gynaecology, Grant Medical College, Mumbai, India
Summary
- The proportion of women infected with Chlamydia trachomatis is in the range 8-40%; of these, half remain asymptomatic.
- Chronic and/or repeated chlamydial infections are more likely than active infections to cause tubal damage and subsequent infertility.
- Newer methods of detecting chlamydia [e.g. enzyme immunoassays (EIAs), nucleic acid probes, laparoscopy/antigen detecting systems are replacing cell culture due to their superior sensitivity and specificity.
- To prevent fallopian tube damage and subsequent tubal infertility, treatment should preferably be initiated when the disease is confined to the endocervix.
Editor's Comment
Chlamydial infections are increasing in incidence worldwide. Delays in diagnosis (and hence treatment) often allow dissemination of the disease with its attendant adverse sequelae, among them tubal infertility. This paper reviews this major health problem (including its impact on fertility), as well as preventive measures and appropriate management approaches.
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Improving Implantation in infertility Therapy - is Tamoxifen the Answer?
Gautam Allahbadia (Consultant)*
Swati Allahbadia**
Rotunda Clinic & Sperm Bank, Bombay Hospital & Medical
Research Centre, The Apollo Clinic*, Department of
Obstetrics & Gynaecology, Lokmanya Tilak Municipal
Medical College & General Hospital, Sion**, Mumbai,
India.
Summary
- Clomiphene citrate (clomiphene) remains the drug of choice among infertility patients, despite a potential relationship with ovarian cancer.
- The present study compared the efficacy of tamoxifen citrate (tamoxifen) versus clomiphene in stimulated cycles for donor insemination.
- Endometrial thickness and differentiation (parameters known to be associated with higher conception rates), assessed by transvaginal ultrasonography (TVS), were more optimal in the tamoxifen group, as compared with the clomiphene group.
- Pregnancy rates (PR) per patient and per cycle were also higher in the tamoxifen group, providing support for this agent as a potential new treatment of choice in infertility.
Editor's Comment
Clomiphene and tamoxifen are at the forefront of the anti-infertility drug armamentarium; the present paper compared these two agents in stimulated cycles for donor insemination. The results which favoured tamoxifen are consistent with the idea that endometrial growth (i.e. thickness and morphology) influences implantation.
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