9. Diagnosis and Management of Unexplained Infertility

  1. Emre Seli MD4,5,6
  1. Cornelis B. Lambalk MD, PhD1,2,
  2. Jan Willem van der Steeg MD, PhD3 and
  3. Pieternel Steures MD, PhD3

Published Online: 8 MAR 2011

DOI: 10.1002/9781444393958.ch9



How to Cite

Lambalk, C. B., van der Steeg, J. W. and Steures, P. (2011) Diagnosis and Management of Unexplained Infertility, in Infertility (ed E. Seli), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444393958.ch9

Editor Information

  1. 4

    Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA

  2. 5

    Division of Reproductive Endocrinology and Infertility, Yale University School of Medicine, New Haven, Connecticut, USA

  3. 6

    Oocyte Donation and Gestational Surrogacy Program, Yale University School of Medicine, New Haven, Connecticut, USA

Author Information

  1. 1

    Department of Reproductive Medicine, VU University Medical Center, Amsterdam, The Netherlands

  2. 2

    University of Gent, Belgium

  3. 3

    Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands

Publication History

  1. Published Online: 8 MAR 2011
  2. Published Print: 23 MAR 2011

Book Series:

  1. Gynecology in Practice

Book Series Editors:

  1. Aydin Arici

ISBN Information

Print ISBN: 9781444333534

Online ISBN: 9781444393958



  • unexplained infertility - diagnosis and management;
  • ovulation induction in women - with anovulation, tubal surgery, ART in women with tubal disease or endometriosis;
  • specific diagnostic procedures - ovulation detection;
  • tubal patency evaluation - and uterine and intra-abdominal factor evaluation;
  • thyroid stimulating hormone (TSH), valuable - subclinical thyroid disease influence on fertility;
  • expectant management - advised, depending on prognosis of a couple;
  • timed intercourse, couples seeking pregnancy - sexual activity in midcycle;
  • intrauterine insemination in couples with unexplained subfertility - IUI, first choice of treatment;
  • ART ovarian hyperstimulation;
  • drawbacks of ART or IUI - with hormonal stimulation


Unexplained subfertility is a diagnosis by exclusion in the diagnostic work-up of known causes of subfertility such as anovulation, tubal occlusion, endometriosis, cervical hostility, and abnormal sperm counts. The basic fertility work-up consists of history-taking, physical examination, ovulation detection, evaluation of tubal patency, a postcoital test, and a sperm analysis. In case of unexplained subfertility a prognosis of a natural conception can be calculated by female age, presence of previous pregnancies, duration of the subfertility, sperm motility, and referral status. The formula for the prognosis can be determined by means of calculators publicly available on the Internet. Treatment is empirical and depends on the prognosis of a natural pregnancy of the couple. The treatment modalities vary from an expectant management to six or more cycles of intrauterine insemination with mild hormonal ovarian stimulation and three or more cycles of in-vitro fertilization.