Treatment of Idiopathic Sterility

Overview

In the Centre for Assisted Reproduction of the Second Gynaecological and ObstetricClinic, First Medical Faculty, Charles University and General Hospital Prague, during the periodfrom 1993 - 1997, 900 couples were examined on account of sterility. In 8%, i.e. 72 couples thecause was not elucidated. The female patients were divided into groups by age, parity and periodof sterility. In these groups the cumulative conception (CCR) was compared as well as the fecun-dity per cycle after three months without treatment, after three cycles of intrauterine inseminati-on (IUI) and after three cycles of in vitro fertilization (IVF) or intracytoplasmic sperm injectioninto the oocyte (ICSI). In the group of patients with sterility shorter than three years, the cumula-tive conception rate after three months without treatment was 34.8%, after the subsequent threecycles of IUI 27.3% and after three cycles of IVF/ICSI 66.7%. In women with sterility extendingover more than three years these results were significantly lower: without treatment CCR was12.5%, when IUI was used it was 16.1% and after IVF/ICSI 40.5%. There were also marked differen-ces in the age groups. Based on these results the authors elaborated an optimal individual thera-peutic pattern. Treatment can be postponed by three months in women under 30 years and thosewhere sterility persists for less than three years. If they do not become pregnant, 3-4 IUI cyclesshould be attempted. Even women where IUI fails have a fair chance to become pregnant by IVFET. In women above 30 years with sterility lasting more than three years there the chance thatthey will become pregnant without treatment is only when secondary sterility is involved. IUIincreases the probability of pregnancy in this group only slightly. If during stimulation before IUImore than four follicles grow, it is advisable to convert these cycles to IVF. In women above 39years the authors recommend IVF or ICSI resp. as the method of first choice.

Key words: