Open AccessUnexplained infertility categorization based on female laparoscopy and total motile sperm count, and its impact on cumulative live‐births after one in‐vitro fertilization cycle. A retrospective cohort study involving 721 cycles
Author(s) -
Satwik Ruma,
Kochhar Mohinder
Publication year - 2021
Publication title -
reproductive medicine and biology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.005
H-Index - 22
eISSN - 1447-0578
pISSN - 1445-5781
DOI - 10.1002/rmb2.12368
Subject(s) - medicine , unexplained infertility , infertility , live birth , in vitro fertilisation , retrospective cohort study , gynecology , obstetrics , laparoscopy , endometriosis , odds ratio , pregnancy , biology , surgery , genetics
Purpose To determine how subcategorizing unexplained infertility based on female laparoscopy and total‐motile‐sperm‐count assessment would impact cumulative live‐births after one in‐vitro fertilization (IVF) cycle. Methods Seven hundred twenty one IVF cycles from Jan 2014‐April 2019 performed at a single‐center were retrospectively analyzed. Couples with unexplained infertility having normal uterine and endometrial morphology were subcategorized into three cohorts, UI (1): those with no tuboperitoneal pathology on laparoscopy and total‐motile‐sperm‐count (TMSC) ≧20 million: n = 103; UI (2): tuboperitoneal pathology on laparoscopy or TMSC <20 million, n = 86; and UI(3): tuboperitoneal status not known: n = 114. Controls were severe male factor, bilateral tubal block, and grade 3/4 endometriosis: n = 418. Primary Outcome was cumulative‐live‐birth‐per‐initiated‐IVF cycle (CLBR). Odds ratio for live‐births were adjusted for confounding factors. Results The CLBR in UI1 cohort was significantly lower than controls (29.1% vs 39; OR = 0.62; 95%CI = 0.39‐0.98; P = .04); but similar in UI2 and UI3 vs. controls. (37.2% vs 39.95%; OR = 0.89, 95%CI = 0.55‐1.44; P = .89) and (38.6% vs 39.95%; OR = 0.98, 95%CI = 0.64‐1.55; P = .98). After adjusting for age, infertility duration, past live‐births, and AMH, the adjusted odds for CLBR in UI1 was 0.48 (95%CI = 0.28‐0.82; P = .007). Conclusions Unexplained infertility when defined after a normal laparoscopy and TMSC significantly lowered cumulative‐live‐births‐per‐initiated‐IVF cycle when compared with traditional diagnosis of tubal, endometriosis, or male factor infertility. In UI subcategory with abnormal laparoscopy or TMSC, CLBR remained unaffected. This information could be useful for counseling couples prior to IVF. Large‐scale prospective studies are needed to confirm this observation.