Unexplained infertility -- the way forward in the fog

June 27, 2000

Three-quarters of couples suffering from unexplained infertility will probably conceive from treatment if doctors follow a 'gold standard' regimen, according to American fertility specialist Professor Michael Soules.

However, he warned the conference of the European Society of Human Reproduction and Embryology in Bologna, Italy, today, (Wednesday 28 June) that wise doctors should remain humble about their 'success' as they could never be certain that conception would not have happened spontaneously anyway.

One in six couples worldwide experience some form of infertility problem and in about 5-10% of these no apparent cause can be found.

Professor Soules, director of the Division of Reproductive Endocrinology in the Department of Obstetrics and Gynaecology at the University of Washington in Seattle, said:"Unexplained fertility is like pre-menstrual syndrome in that the disease is not defined. You are presented with a couple whose tests show nothing is apparently amiss and you have to tell them that you are approaching their treatment from a perspective of medical ignorance when it comes to the cause of their problem."

He said that a watch-and-wait approach for 6 to 12 months was justified in couples under 35 who had been trying to conceive for less than two years; in the case of a couple over 35 who had been trying for more than three years, immediate aggressive treatment was appropriate.

The first step though was careful evaluation to make sure no subtle causes of infertility had been overlooked -- conditions such as inflammation of the cervix or lining of the womb, antibodies to the sperm or problems involving implantation of the embryo immediately after fertilisation

Then treatment should follow five escalating steps:"In my experience about 75% of couples with unexplained infertility will conceive following this programme. However, it is wise to remain humble, as you cannot be certain that any particular pregnancy that is achieved would not have occurred spontaneously," said Professor Soules.
-end-
Notes: programme number: O-213

+ = empirical recommendations
* = proven recommendations in unexplained fertility

Further information:
Margaret Willson (media information officer)
Tel: 44-1536-772181
Fax: 44-1536-772191
Mobile: 973-853347
Email: m.willson@mwcommunications.org.uk

Press office (Sunday 25 June -- Wednesday 28 June)
Margaret Willson, Emma Mason, Elisabetta Sestini
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European Society of Human Reproduction and Embryology

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