Methods of Treatment Available
Our recommendations for treatment options are based on international best practice. Female partner age, duration of infertility and time to diminished ovarian reserve are very important determining factors.
With expectant management we advise couples to maintain normal and frequent coital activity without treatment. They may add detection of ovulation using commercial ovulation detection kits with timed intercourse. This options is only suitable for young couples (female partner age < 30 years) with duration of infertility < 2 years and a history of pregnancy in the same relationship and a diagnosis of unexplained infertility (thorough systematic evaluation of both partners with standard diagnostic tests such as semen analysis, evaluation of uterine cavity, tubal patency and ovulation fail to establish a known cause for the infertility).
Natural Cycle Intrauterine Insemination (IUI)
Natural cycle IUI involves the introduction of washed and concentrated motile sperm into the uterine cavity and near the tubal ostia hours before or after ovulation to enable more sperm travel a shorter distance to reach the site of fertilization. It requires use of ovulation detection kits near the estimated time of ovulation or frequent visits to the hospital for tracking development of the follicles(that contain eggs) with scans and ovulation trigger or semen production.
It appears a more acceptable option of treatment compared to expectant management for couples with unexplained infertility and mild male factor infertility
Ovulation Induction with Intrauterine Insemination (IUI)
Ovulation induction aims to cause release of eggs by anovulating women or increase the number of eggs released every month with the assumption that this increases the number of eggs available for fertilization or implantation, and by extension, the chance of pregnancy. It may be combined with IUI, especially in couples with normal sperm count and morphology (structure) but weak motility. Establishment of tubal patency and normal uterine cavity is a pre-requisite. The ovulation induction can be achieved with oral medications (e.g. clomiphene citrate, tamoxifen, letrozole, and metformin) or by injections (gonadotropins FSH or hMG)
This appears to increase the pregnancy rate per month among couples with unexplained infertility and mild male factor, especially when combined with IUI.
It is more expensive than expectant management or natural cycle IUI and also requires frequent scans for tracking development of follicles (that contain eggs) and ovulatory trigger as well as semen production for insemination.
However, many patients with unexplained infertility and mild male factor infertility are happier with this treatment than expectant management or natural cycle IUI because of its modest cost and good results