Unexplained subfertility Treatment options and safety insights

The work presented in this thesis focuses on couples with unexplained subfertility and a poor prognosis for natural conception. First, we investigated the effectiveness of six months of expectant management (EM) compared to six months of intrauterine insemination with ovarian stimulation (IUI-OS) within this specific group. We conclude that, for couples with unexplained subfertility and a poor prognosis for natural conception, EM is inferior compared to IUI-OS.
Second we evaluated health-related quality of life (HRQoL), anxiety and depression scores and coital frequency in both treatment groups. The results indicated that while EM led to lower HRQoL scores in the relational domain, anxiety and depression levels remained comparable between the two groups. The coital frequency was higher in the EM group during the fertile window.
Further analysis, including individual participant data meta-analysis, highlighted that gonadotrophins used in IUI-OS significantly improved live birth rates compared to clomiphene citrate, although they also increased the risk of multiple pregnancies. When a lower starting dose and stricter cancellation criteria are in place, both gonadotrophins and clomiphene citrate seems effective. Lastly, we examined perinatal outcomes, demonstrating that singleton births resulting from IUI-OS or IVF had different birth weights compared to those conceived naturally, underscoring the importance of monitoring perinatal health in assisted reproduction scenarios. The last chapter is an overview of the potential overuse of IVF and the alternatives.