MedWire News: Most General Practitioner-referred couples with unexplained infertility will ultimately conceive within 3 years of their first physician visit, with the majority achieving a spontaneous pregnancy (SP), show study findings.

"We therefore recommend that if the pregnancy prognosis is good, treatment should at least begin with expectant management," suggest Monique Brandes (Jeroen Bosch Hospital, The Netherlands) and colleagues. They define pregnancy prognosis according to the model of Hunault et al, which accounts for duration of infertility, the woman's age, and her obstetric history.

Over a 5-year follow-up, 81.5 percent of the 437 couples studied conceived an ongoing pregnancy. Of these, 98.6 percent were conceived within 3 years of visiting the physician, and 73.9 percent were spontaneous.

Of the 184 couples who started treatment with intra-uterine insemination (IUI) or IVF, 42.3 and 62.8 percent achieved a pregnancy, respectively. However, this included a respective 14.7 and 11.7 percent of couples who conceived spontaneously despite treatment.

Of the couples classed as having a "good" pregnancy prognosis (≥30 percent likelihood of SP on Hunault model; n = 399), 83.7 percent conceived; 65.4 percent spontaneously. Almost all (97.0 percent) were initially treated with the recommended strategy of expectant management.

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