Efficacy of treatment for unexplained infertility.
OBJECTIVE
To analyze the efficacy and cost-effectiveness of alternative treatments for unexplained infertility.


METHODS
Retrospective analysis of 45 published reports.


METHODS
Clinical practices.


METHODS
Couples who met criteria for unexplained infertility. Women with Stage I or Stage II endometriosis were included.


METHODS
Observation; clomiphene citrate (CC); gonadotropins (hMG); IUI; and GIFT and IVF.


METHODS
Clinical pregnancy rate.


RESULTS
Combined pregnancy rates per initiated cycle, adjusted for study quality, were as follows: no treatment = 1.3%-4.1%; IUI = 3.8%; CC = 5.6%; CC + IUI = 8.3%; hMG = 7.7%; hMG + IUI = 17.1%; IVF = 20.7%; GIFT = 27.0%. The estimated cost per pregnancy was $10,000 for CC + IUI, $17,000 for hMG + IUI, and $50,000 for IVF.


CONCLUSIONS
Clomiphene citrate + IUI is a cost-effective treatment for unexplained infertility. If this treatment fails, hMG + IUI and assisted reproduction are efficacious therapeutic options.
University of Rochester, New York, USA.
D S
DS
Guzick
M W
MW
Sullivan
G D
GD
Adamson
M I
MI
Cedars
R J
RJ
Falk
E P
EP
Peterson
M P
MP
Steinkampf
D003362:Cost-Benefit Analysis; D005260:Female; D005307:Fertilization in Vitro; D015181:Gamete Intrafallopian Transfer; D006801:Humans; D007246:Infertility / Q000209:etiology / Q000628:therapy*; D007315:Insemination, Artificial; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013480:Superovulation