Unexplained infertility: A French national survey of clinical practices

Abstract

Introduction: The aim of our study was to carry out a national survey of French practitioners to evaluate (i) their diagnostic criteria for making a diagnosis of unexplained infertility (UEI) and (ii) their management strategy when facing UEI.

Materials and method: An online questionnaire comprising ten multiple-choice questions was sent by mail to French reproductive practitioners in 80 fertility centres.

Results: The response rate was 59.6% (195/327). Post coital testing was always or often prescribed by 14.8% of respondents (n = 36). Chlamydia trachomatis testing was never prescribed by 31.7% (n = 59) of them, 30.2% prescribed a pelvic MRI in cases of UEI and 18.4% (n = 33) always or often performed laparoscopy. For 87.6% (n = 169), advanced maternal age was always or often an indication of first-line IVF, with an average threshold of 37.4 years. For 68.6% (n = 129), diminished AMH was an indication for first-line IVF, with an average AMH threshold of 1.2 ng/ml. With respect to the management of UEI, we did not observe a consensus between the strategies of 2 to 6 intrauterine insemination cycles before IVF or IVF as the first-line treatment.

Conclusion: There is no consensus in France on what tests should or should not be carried out to conclude UEI, and there is also no consensus on the management of UEI. UEI is one of the top 10 priorities for future infertility research. The diagnostic criteria must be standardized to enable the comparison of studies on this topic as well as to improve the translation of research into clinical practice.

Keywords: Clinical practices; Diagnosis; Management; Unexplained infertility.