EFFICACY OF TREATMENT FOR UNEXPLAINED INFERTILITY

Objective: To analyze the efficacy and cost-effectiveness of alternati ve treatments for unexplained infertility. Design: Retrospective analy sis of 45 published reports. Setting: Clinical practices. Patient(s): Couples who met criteria for unexplained infertility. Women with Stage I or Stage II endometriosis were included. Intervention(s): Observati on; clomiphene citrate (CC); gonadotropins (hMG); IUI; and GIFT and IV F. Main Outcome Measure(s): Clinical pregnancy rate. Result(s): Combin ed pregnancy rates per initiated cycle, adjusted for study quality, we re as follows: no treatment = 1.3%-4.1%; IUI = 3.8%; CC = 5.6%; CC + I UI = 8.3%; hMG = 7.7%; hMG + IUI = 17.1%; IVF = 20.7%; GIFT = 27.0%. T he estimated cost per pregnancy was $10,000 for CC + IUI, $17,000 for hMG + IUI, and $50,000 for IVF. Conclusion(s): Clomiphene citrate + IU I is a cost-effective treatment for unexplained infertility. If this t reatment fails, hMG + IUI and assisted reproduction are efficacious th erapeutic options. (Fertil Steril(R) 1998;70:207-13. (C)1998 by Americ an Society for Reproductive Medicine.).