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Efficacy of treatment for unexplained infertility
D S Guzick1, M W Sullivan, G D Adamson
1University of Rochester, New York, USA.
Objective:
To analyze the efficacy and cost-effectiveness of alternative treatments for unexplained infertility.
Design:
Retrospective analysis 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):
Observation; clomiphene citrate (CC); gonadotropins (hMG); IUI; and GIFT and IVF.
Main Outcome Measure(S):
Clinical pregnancy rate.
Result(S):
Combined pregnancy rates per initiated cycle, adjusted for study quality, were as follows: no treatment = 1.3%-4.1%; IUI = 3.8%; CC = 5.6%; CC + IUI = 8.3%; hMG = 7.7%; hMG + IUI = 17.1%; IVF = 20.7%; GIFT = 27.0%. The estimated cost per pregnancy was $10,000 for CC + IUI, $17,000 for hMG + IUI, and $50,000 for IVF.
Conclusion(S):
Clomiphene citrate + IUI is a cost-effective treatment for unexplained infertility. If this treatment fails, hMG + IUI and assisted reproduction are efficacious therapeutic options.
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