Diagnosis and Management of Unexplained Infertility

Cornelis B. Lambalk, Jan Willem van der Steeg, Pieternel Steures

Research output: Chapter in Book/Report/Conference proceedingChapterAcademicpeer-review

1 Citation (Scopus)


Unexplained subfertility is a diagnosis by exclusion in the diagnostic work-up of known causes of subfertility such as anovulation, tubal occlusion, endometriosis, cervical hostility, and abnormal sperm counts. The basic fertility work-up consists of history-taking, physical examination, ovulation detection, evaluation of tubal patency, a postcoital test, and a sperm analysis. In case of unexplained subfertility a prognosis of a natural conception can be calculated by female age, presence of previous pregnancies, duration of the subfertility, sperm motility, and referral status. The formula for the prognosis can be determined by means of calculators publicly available on the Internet. Treatment is empirical and depends on the prognosis of a natural pregnancy of the couple. The treatment modalities vary from an expectant management to six or more cycles of intrauterine insemination with mild hormonal ovarian stimulation and three or more cycles of in-vitro fertilization.

Original languageEnglish
Title of host publicationInfertility
Number of pages7
ISBN (Print)9781444333534
Publication statusPublished - 8 Mar 2011


  • ART ovarian hyperstimulation
  • Drawbacks of ART or IUI -with hormonal stimulation
  • Expectant management -advised, depending on prognosis of a couple
  • Intrauterine insemination in couples with unexplained subfertility -IUI, first choice of treatment
  • Ovulation induction in women -with anovulation, tubal surgery, ART in women with tubal disease or endometriosis
  • Specific diagnostic procedures -ovulation detection
  • Thyroid stimulating hormone (TSH), valuable -subclinical thyroid disease influence on fertility
  • Timed intercourse, couples seeking pregnancy -sexual activity in midcycle
  • Tubal patency evaluation -and uterine and intra-abdominal factor evaluation
  • Unexplained infertility -diagnosis and management

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