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Investigating unexplained infertility.

C B Coulam1, S B Moore, W O'Fallon

  • 1Methodist Center for Reproduction and Transplantation Immunology, Indianapolis, IN.

American Journal of Obstetrics and Gynecology
|June 1, 1988
PubMed
Summary
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Further investigation of unexplained infertility using advanced diagnostics like ultrasound and HLA typing can identify causes in 60% of couples. These methods help diagnose luteinized unruptured follicle, sperm antibodies, and low sperm penetration, improving infertility evaluations.

Area of Science:

  • Reproductive Medicine
  • Immunogenetics
  • Infertility Diagnostics

Background:

  • Unexplained infertility (UI) affects numerous couples, with basic evaluations often failing to identify an etiology.
  • Advanced diagnostic techniques are needed to elucidate the causes of UI.

Purpose of the Study:

  • To investigate the utility of advanced diagnostic tools in reducing the diagnosis of unexplained infertility.
  • To identify specific causes of infertility in couples previously diagnosed with UI.

Main Methods:

  • Ultrasound monitoring of folliculogenesis.
  • Sperm antibody testing.
  • Hamster egg penetration assay.
  • Major histocompatibility (human leukocyte antigen) typing.

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Main Results:

  • Specific diagnoses were identified in a significant portion of couples: luteinized unruptured follicle (5%), sperm antibodies (5%), low sperm penetration (11%), and human leukocyte antigen-B locus homozygosity (37%).
  • A significant difference in HLA-B locus homozygosity was observed between couples with UI and fertile controls (p = 0.025).
  • The combined diagnostic approach reduced the diagnosis of unexplained infertility by 60%.

Conclusions:

  • Advanced diagnostic methods significantly increase the identification of specific causes in couples with unexplained infertility.
  • Human leukocyte antigen typing, particularly B locus homozygosity, may play a role in infertility.
  • Implementing these advanced tests can substantially decrease the rate of unexplained infertility diagnoses.