A 34 year old woman with her 35 year old partner has been referred to the infertility clinic because of 2 years of primary infertility. The woman has a regular and normal 28 day cycle, her BMI is 26 and she has no other symptoms. Investigations have shown normal LH = 3.5mIU/ml, FHS = 5.0mIU/ml, Thyroid function tests, prolactin and day 21 progesterone concentration confirms ovulatory cycles. Her partner?s semen analysis is normal. Hystero-salpingogram confirms bilateral patent fallopian tubes.
the answer was IUI????
why not IVF
Posted by Farrukh G.
Thanks - the correct answer is IVF. Our team will identify and review this question.
Notes below
UNEXPLAINED INFERTILITY (MRCOG 2 Jan 2019 / 2016)
Affects about 15 - 37% of the couples seeking medical advice for infertility
Diagnosis of exclusion and prevalence is dependent on the investigations undertaken before the diagnosis is applied
Many of these couples will conceive and go on to have a live birth without treatment. The spontaneous pregnancy rate in couples with unexplained infertility has been reported as 2% to 4% per menstrual cycle. Overall, about 15% of couples diagnosed with unexplained infertility will conceive without treatment within 1 year and 35% within 2 years
Cumulative pregnancy rate over 3 years without treatment has been reported to be up to 80% in some groups
Age of the woman is the most important predictor of successful conception without treatment with the rates falling at a greater rate after age 30 years
Couples with unexplained infertility are often given advice on lifestyle and successful conception, and told to return in a few months if they have still not become pregnant (expectant management)
However, expectant management is often not attractive to couples (or their clinicians)
Recommendations
Do not offer oral ovarian stimulation agents (such as clomifene citrate, anastrozole or letrozole) to women with unexplained infertility
Inform women with unexplained infertility that clomifene citrate as a stand-alone treatment does not increase the chances of a pregnancy or a live birth
Advise women with unexplained infertility who are having regular unprotected sexual intercourse to try to conceive for a total of 2 years (this can include up to 1 year before their fertility investigations) before IVF will be considered
Offer IVF treatment to women with unexplained infertility who have not conceived after 2 years (this can include up to 1 year before their fertility investigations) of regular unprotected sexual intercourse (MRCOG II 2016)
Posted by Farrukh G.
Was this an SBA or EMQ? We are still unable to identify the question in our database.
