Evidence-based Treatments for Couples with Unexplained Infertility

Patient Guideline Summary

Publication Date: February 1, 2020
Last Updated: March 2, 2023

Objective

Objective

This patient summary means to discuss key recommendations from the American Society for Reproductive Medicine (ASRM) for evidence-based treatments for couples with unexplained infertility.

Overview

Overview

  • Infertility is the inability to become pregnant by natural means. In 70% of cases, the cause can be identified and cause-specific treatments can be pursued. The remaining 30% may undergo several treatment trials to become pregnant before considering in vitro fertilization (IVF) (the process of becoming pregnant using a medical laboratory instead of having sexual intercourse).
  • This patient summary lists several procedures to enhance fertility when the cause is not known.

Diagnosis

Diagnosis

  • An initial evaluation will determine if your and your partner’s anatomy and hormone function are normal, thereby ruling out a specifically treatable cause.

Treatment

Treatment

  • Several attempts will be made to enhance your fertility:
    • Clomiphene is a tablet that stimulates your production of eggs. It is combined with the instillation of sperm into the womb.
    • Letrozole, a tablet that is used to treat breast cancer, can be used in place of clomiphene. It alters the production of sex hormones. It is not approved by the U.S. Food and Drug Administration (FDA) for infertility.
    • Human chorionic gonadotrophin (hCG), a natural hormone that supports pregnancy, can be injected as a shot at the same time as sperm is instilled into the womb.
    • The ASRM recommends IVF rather than hCG.

Abbreviations

  • FDA: Food And Drug Administration
  • IVF: In Vitro Fertilization
  • hCG: Human Chorionic Gonadotropin

Source Citation

Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org; Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020 Feb;113(2):305-322. doi: 10.1016/j.fertnstert.2019.10.014. PMID: 32106976.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.