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INTRODUCTION Endometrial injury (ES) has been suggested as intervention to increase probability of pregnancy in women undergoing assisted reproductive technologies. Majority of studies reported that ES improves outcome in Invitro fertilisation,Intrauterine Insemination(IUI) and natural conceptions: however, the size and quality of studies are poor which questions the presence of any beneficial effect. The present study was done to evaluate the effect of endometrial scratching on pregnancy rate after previous failed Intrauterine Insemination and to assess the pain and bleeding following the procedure. MATERIAL AND METHODS Randomized controlled trial. One hundred sixty-eight women (Eighty-four in each group) with primary/secondary infertility were recruited and randomized into intervention and control group using block randomization. Intervention group underwent ES using pipelle's canula on D8 or D9 of menstrual cycle. Three cycles of ovulation induction with Clomiphene citrate and gonadotrophins followed by IUI was done. The primary end point was clinical pregnancy rate. Pain and bleeding after the procedure were evaluated as secondary outcomes.The study was conducted from June 2017 to June 2019. MAIN RESULTS The cumulative clinical pregnancy rate in ES group was 22.2 % in comparison 9.8 % in control group. In the intent to treat analysis, with a p value of 0.03 calculated from Chi-square test(p

Objective To evaluate long-term reproductive outcomes in couples who were enrolled in a large randomized controlled trial that studied optimal treatment for unexplained infertility. Design Telephone survey, administered between March 2019 and February 2020. Setting Large urban university-affiliated fertility center. Patient(s) Couples who enrolled in the Fast Track and Standard Treatment Trial (FASTT). Intervention(s) None. Main Outcomes Measure(s) Number of live births, methods of conception, adoption, and satisfaction regarding family size. Result(s) Of the 503 couples enrolled in FASTT, 311 (61.8%) were contacted and 286 (56.9%) consented to participate. The mean age and follicle-stimulating hormone level at the time of enrollment in FASTT were 33.1 ± 3.2 years and 6.8 ± 2.2 mIU/mL, respectively, for those who participated in this study. The mean age at follow-up was 49.5 ± 3.4 years. Of the 286 women, 194 (67.8%) had a live birth during the trial and 225 (78.7%) continued to try to conceive after FASTT. Of those who tried to conceive without treatment, 101 of 157 (64.3%) had a successful live birth, whereas 12 (5.3%) women had a live birth via intrauterine insemination and 82 (36.4%) via autologous oocyte in vitro fertilization. Overall, 182 (80.9%) women achieved a live birth after FASTT. Conclusion(s) The majority of couples were able to achieve a live birth after FASTT. Only 19 (6.6%) never achieved a live birth during their reproductive years. Moving to treatment sooner allows the opportunity to achieve >1 live birth, which is associated with increased satisfaction regarding family size. This further supports access to care and insurance coverage for infertility treatment.

We and others have previously shown that abnormal pelvic environment plays an important role in the unexplained infertility of endometriosis. However, whether iron overload caused by ectopic periodic bleeding found in patients with endometriosis participates in endometriosis-associated reproductive failure is unknown. This study aimed to investigate effects of iron at level relevant to pelvic iron overload on the development of preimplantation mouse embryo. Two-cell embryos were collected, and cultured to blastocysts in G1/G2 medium supplemented with iron alone or in combination with iron chelator. The development rates, ATP level, mitochondrial membrane potential (MMP), reactive oxygen species level (ROS), and apoptotic and ferroptotic indices were compared between control and iron treatments across each specific developmental stage. Prolonged exposure to iron remarkably impaired early embryo development in vitro by hampering blastocyst formation (P < 0.001), which could be partly restored by iron chelator (P < 0.001). The arrest of embryo development was linked with iron-initiated mitochondrial dysfunction with reduction of ATP generation and MMP (P < 0.05 and P < 0.001, respectively). Impaired mitochondria altered ROS accumulation post-iron exposure at morula stage and blastocyst stage (P < 0.05). Moreover, Iron-exposed blastocyst stage embryos showed higher apoptotic and ferroptotic rates (P < 0.001 and P < 0.05, respectively). Our results highlight that pathologically relevant level of iron compromises preimplantation mouse embryo development by disrupting mitochondrial function and triggering both apoptosis and ferroptosis, which implicates that excess iron found in peritoneal fluid of women with endometriosis likely participates in endometriosis-associated reproductive failure.

Do bisphenol A (BPA) levels in maternal urine, serum and follicular fluid affect embryo quality and intracytoplasmic sperm hinjection (ICSI) cycle outcomes in women with unexplained infertility?Prospective study conducted between 1 April 2019 and 30 September 2019. The study cohort consisted of 82 women aged between 23 and 33 years who underwent intracytoplasmic sperm injection owing to unexplained infertility and provided urine, blood and follicular fluid samples on the day of oocyte retrieval. Consumption of drinking water from plastic carboys or bottles at home were considered as chronic BPA exposure. Demographic features and IVF outcomes of the patients were collected.Among the 82 women with unexplained infertility, clinical pregnancy was achieved in 22 (26.8%) patients after the IVF and embryo transfer cycle. The patients who consumed tap water had statistically significantly lower BPA values in three body fluids compared with patients who consumed plastic bottled water (all P0.001). Women who had grade 1 embryos transferred had lower serum BPA values than women who had grade 2 embryos transferred (10.8 ± 5.2 versus 26.9 ± 22 ng/ml, P = 0.003). Serum and follicular fluid BPA levels were statistically significantly higher in women who failed to achieve clinical pregnancy (P0.001, P = 0.006, respectively) and obtain a live birth (both P = 0.007).A negative relationship was found between serum and follicular fluid BPA levels and embryo quality, clinical pregnancy and live birth in these women. In addition, the BPA levels of women who consume tap water at home were lower than those who use plastic bottled water.

Objective: To study decidualization-associated endometrial factors. Design: Retrospective cohort study to compare endometrial gene expression patterns in women experiencing reproductive failure including recurrent pregnancy loss or unexplained infertility versus fertile controls. Setting: University Reproductive Medicine Center. Patient(s): Women experiencing recurrent reproductive failure including recurrent pregnancy loss or unexplained infertility (n = 42) and fertile controls (n = 18). Intervention(s): Endometrial biopsy samples were analyzed with targeted ribonucleic acid sequencing via next-generation sequencing. Main Outcome Measure(s): The primary end point measurements were the expression of genes important for endometrial transformation during decidualization measured singly and in a combined/cumulative score approach. The secondary end point measurements were receiver operating curve analysis and comparisons between the specific biomarkers. Result(s): The comparison revealed differential expression of factors associated with decidualization, tissue homeostasis, and immune regulation: FOXO1, GZMB, IL15, SCNN1A, SGK1, and SLC2A1. A combined evaluation of these 6 signature factors was designated as a decidualization score in which the maximal score was “6” and the minimal was “0”. Among controls, 89% of the samples had a score ≥5 and 11% had a score of “4”. A total of 76% of samples in the patient group had scores ≤4 and 19% had the lowest score of “0”. A decidualization score

Meiosis is pivotal for sexual reproduction and fertility. Meiotic programmed DNA double-strand breaks (DSBs) initiate homologous recombination, ensuring faithful chromosome segregation and generation of gametes. However, few studies have focused on meiotic DSB formation in human reproduction. Here, we report four infertile siblings born to a consanguineous marriage, with three brothers suffering from non-obstructive azoospermia and one sister suffering from unexplained infertility with normal menstrual cycles and normal ovary sizes with follicular activity. An autosomal recessive mutation in TOP6BL was found co-segregating with infertility in this family. Investigation of one male patient revealed failure in programmed meiotic DSB formation and meiotic arrest prior to pachytene stage of prophase I. Mouse models carrying similar mutations to that in patients recapitulated the spermatogenic abnormalities of the patient. Pathogenicity of the mutation in the female patient was supported by observations in mice that meiotic programmed DSBs failed to form in mutant oocytes and oocyte maturation failure due to absence of meiotic recombination. Our study thus illustrates the phenotypical characteristics and the genotype-phenotype correlations of meiotic DSB formation failure in humans.

Objective To determine whether intracytoplasmic sperm injection (ICSI) is associated with improved outcomes compared with conventional in vitro fertilization (IVF) for patients with nonsevere male factor infertility. Design Retrospective cohort. Setting University-affiliated reproductive endocrinology unit. Patient(s) Couples who received their first-cycle embryo transfer without severe oligoasthenozoospermia (OA) between January 2012 and December 2016 were included in this study. Intervention(s) Six subgroup analyses were performed according to the proposed indications for the use of ICSI as follows: non−male factor infertility, advanced maternal age (≥38 years), unexplained infertility, low oocyte yield (≤6), mild OA, and moderate OA. Main Outcome Measure(s) Live birth rates and selected perinatal outcomes. Result(s) ICSI resulted in live birth rates similar to those achieved with IVF (41.68% vs. 44.31%). There were no significant differences in the incidences of gestational diabetes mellitus, hypertension disorder of pregnancy, placental previa, postpartum hemorrhage, cesarean delivery, fetal macrosomia, small for gestational age, large for gestational age, neonatal intensive care unit (NICU) admission, and congenital anomalies between the two groups. Subgroup analyses showed that ICSI resulted in a lower rate of NICU admission in couples with moderate OA. Conclusion(s) Our results suggested that routine use of ICSI for all causes of infertility did not result in better pregnancy and perinatal outcomes compared with conventional IVF in the first cycle. ICSI might be associated with a lower risk of NICU admission when used in couples with moderate OA. Large prospective studies are required to validate our current findings.

© 2020 Elsevier B.V.Objective: The aim of this study was to determine whether the progesterone-induced blocking factor (PIBF) level in women with unexplained infertility differed from that in fertile women. Study design: Volunteers between 18 and 35 years old were included in this cross-sectional study and were divided into two groups—the unexplained-infertility group and the control group. Demographic data on all the women were collected using a detailed questionnaire. The infertile participants and their male partners received complete infertility examinations according to the protocol. Blood samples were taken from all participants after the examinations during regular clinic visits. Serum PIBF levels were measured using an enzyme-linked immunosorbent assay. Results: Of the 46 healthy participants in the study, 22 had unexplained infertility. Age, body mass index, ethnicity, education level, age at first menarche, and length of menstrual cycles, serum follicle stimulating hormone, luteinizing hormone, estradiol, prolactin, thyroid stimulating hormone, and progesterone were similar between two groups. The mean right antral follicle count (AFC) was 6.6 ± 1.8 in the unexplained-infertility group and 6.5 ± 2.0 in the control group. The mean left AFC was 6.6 ± 2.0 in the unexplained-infertility group and 6.9 ± 1.5 in control group. The mean serum PIBF level was 6.92 ± 3.41 ng/mL in the unexplained-infertility group and 12.10 ± 10.47 ng/mL in the control group, which was a significant difference (p = 0.02). Conclusion: The present study showed that serum PIBF levels were significantly lower in unexplained-infertility group than in the fertile control group.

Background The leptin receptor (LEPR) gene, is a member of the class I cytokine receptor superfamily, with six known isoforms. Animal as well as human modal both studies indicate that LEPR have important and powerful roles in the mechanism of obesity. This study aims to determine the correlation of the LEPR genetic variant with obesity and leptin level in the obese and control groups in the northern Indian population. Methods 109 fertile controls and 120 unexplained infertile cases were recruited. Serum leptin level was measured by active human ELISA kit using an ELISA reader. Leptin receptor gene polymorphism A668G, A326G and G1968C were analyzed by polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP). Results The anthropometric parameters are slightly higher in obese cases as compared to control group (p > 0.005), whereas waist circumference and hip circumference shows a significant p- value (p Conclusion Genetic variants (Gln223Arg), (Lys109Arg) and (Lys656Asn) in LEPR gene are significantly associated with anthropometric parameter obesity and leptin level in northern Indian population.

Objective To determine whether biochemical or clinical markers of androgenic activity predict live birth rate with ovarian stimulation in the unexplained infertility population. Design Secondary analysis of the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial. Setting Multicenter university-based clinical practices. Patient(s) Nine hundred couples with unexplained infertility were included. Women were 18–40 years old with regular menses, a normal uterine cavity, at least one patent fallopian tube, and a male partner with ≥5 million motile sperm. Women were randomized to receive gonadotropin, clomiphene, or letrozole with IUI for four or fewer four treatment cycles. Women were evaluated for biochemical (total testosterone, DHEAS, and free androgen index) and clinical markers of androgenic activity (sebum, acne, and hirsutism). Multivariable logistic regression models adjusting for treatment group, maternal age, and body mass index were performed. Intervention(s) None. Main Outcome Measure(s) The primary outcome was live birth. Secondary outcomes included conception, clinical pregnancy, and pregnancy loss. Result(s) When comparing 900 women in the AMIGOS trial based on quartiles of serum TT, women were of younger age, higher body mass index, and higher waist circumference with increasing TT. Increasing quartiles of TT also showed increasing DHEAS and free androgen index values. Serum androgens were not associated with outcomes of live birth, conception, clinical pregnancy, or pregnancy loss. Clinical androgen markers were not associated with pregnancy outcomes. Conclusion(s) In a randomized cohort of women with unexplained infertility, biochemical and clinical measures of androgens did not predict live birth rate after ovarian stimulation treatment. Clinical Trial Registration Number NCT 01044862.

Infertility affects 1 in 7 couples. An etiological diagnosis is made to plan treatment. In a quarter no diagnosis can be established, hence a diagnosis of unexplained infertility is made. IF conception does not happen after an etiological diagnosis based treatment or unexplained infertility is diagnosed, in-vitro fertilisation (IVF) is the treatment of choice. Over last 4 decades IVF processes have evolved. There are better tests to predict ovarian response and a number of stimulations regimen to choose from. Better prediction means ovarian hyperstimulation can be predicted and minimised. Cryopreservation of gametes and embryos have become vert successful process, to the extent that policy of freeze all for all has been discussed. It is important that advances in this field are properly evaluated before being put in routine clinical practice for not only pregnancy rates but long term outcomes.

Research question Human DEFB126 is an important component of the glycocalyx of human spermatozoa. Beta-defensins play a primary role in male infertility due to their involvement in maturation and capacitation of spermatozoa. A 2-nt deletion of DEFB126 affects sperm function and so this study investigated the possible association between DEFB126 variants and its protein expression on medically assisted reproduction (MAR) technique outcome in Iranian infertile males. Design The presence of a 2-nt deletion of DEFB126, and its protein expression in spermatozoa, were investigated by standard polymerase chain reaction (PCR) sequencing and immunocytochemistry, respectively. MAR technique outcome according to clinical pregnancy rates was assessed in 277 Iranian males with unexplained infertility, including 139 patients who underwent intrauterine insemination (IUI) and 103 patients who underwent IVF/intracytoplasmic sperm injection (ICSI), as well as 35 infertile males who declined to use any MAR treatment. As the control group, 100 fertile males with a normal spermiogram were enrolled. Results The 2-nt deletion of DEFB126 was significantly higher in infertile patients than controls (P ≤ 0.05). The presence of this deletion resulted in significantly lower clinical pregnancy rates following IUI (P ≤ 0.05); however, there were no differences in IVF/ICSI outcomes according to genotype. The protein expression in del/del males was also remarkably lower than that of the other genotypes. Conclusions This sequence variation of DEFB126 may impair male reproductive function and can be related to male infertility. Interestingly, males with the del/del genotype have a normal spermiogram; however, their spermatozoa are evidently functionally impaired, which can affect IUI treatment outcome, but not treatment by IVF/ICSI.

Unexplained infertility is a common diagnosis affecting as many as 50% of couples seeking infertility care. As a diagnosis of exclusion, its treatment remains largely empirical. Historically, a step-wise progression in treatment has been initiated with the least invasive, least expensive option followed by a gradual progression to therapies using assisted reproductive technology. In recent years there have been advocates for more rapid-progression IVF. This guideline from the Canadian Fertility and Andrology Society (CFAS) provides comprehensive, evidence-based recommendations for the treatment of unexplained infertility, including expectant management, laparoscopy, intrauterine insemination (IUI) alone, ovarian stimulation with oral agents or gonadotropins alone, ovarian stimulation + IUI, and IVF. The quality of supporting evidence for each recommendation is evaluated using the framework outlined by the Canadian Task Force on Preventive Health Care. This guideline recognizes that the therapeutic approach should be individualized taking into account patient age and duration of infertility, and emphasizes those strategies that are most likely to result in a healthy live birth.

Celiac disease is associated with higher risk of infertility, recurrent abortions, and adverse outcomes in pregnancy and in puerperium. The aim of the study was to analyse the association between celiac disease and reproductive disorders in the group of celiac patients and compare these to healthy controls.A retrospective case-control matched study. The association between celiac disease and menstrual cycle, gyneco-obstetrical complications was assessed with a questionnaire specifically developed for the study. 144 celiac women and 61 celiac men, members of Slovenian Celiac Society, together with 71 healthy women and 31 healthy men participated in the study.A higher percentage of celiac women (27.1%) had difficulties in conception of the first child when compared to healthy controls (12.7%) (p = 0.042). In addition, celiac women experienced more complications than healthy controls during the pregnancy, such as abortions or intrauterine growth retardation (p 0.005). In our study, the prevalence of reproductive problems was not the same in celiac males and females. Altogether 2 celiac men (3.3%) reported having fertility problems, however, the difference between male cases and controls was not statistically significant (p = 0.548).Physicians should examine women with unexplained infertility, recurrent abortions or intrauterine growth retardation for undiagnosed celiac disease. Compared with healthy women, women with celiac disease have increased risk of spontaneous abortions, preterm delivery and fewer successful pregnancies.

Objective: Intrauterine insemination (IUI) is frequently used to treat patients with ovulation disorders, cervical factor, mild male infertility and unexplained infertility. The aim of this study was to investigate the impact of modified speculum application on the success of IUI in patients with unexplained infertility. Materials and methods: This prospective randomized study reviewed 219 women who had undergone controlled ovarian hyperstimulation (COH)-IUI treatment. In the modified speculum application group (109 patients with 124 cycles), the screw of the vaginal speculum was loosened after passing the internal os with catheter and the vaginal speculum remained in this position to ensure closure of the cervix during the procedure. In the conventional speculum application group (110 patients with 132 cycles), the screw of the vaginal speculum was not loosened to close the lips of cervix after passing the internal os with the catheter and the vaginal speculum was removed after withdrawal of the insemination catheter. The primary outcome was live birth rate. Results: The modified and conventional speculum application groups had statistically similar demographic and clinical characteristics. There were no significant differences between the study and the control groups in terms of the clinical pregnancy rate per cycle and per patient (24.1% vs 18.9% and 26.6% vs 22.7%, respectively), as well as the live birth rate per cycle and per patient (19.3% vs 15.1% and 22% vs 18.1% respectively). Conclusion: Applying gentle mechanical pressure on the portio vaginalis of the cervix using a vaginal speculum during IUI does not improve pregnancy and live birth rates in patients with unexplained infertility. Keywords: Intrauterine insemination, Controlled ovarian hyperstimulation, Speculum, Technique

Background Evidences from human and animal studies suggest that reproductive function may be affected by mercury. The aim of this review was to explore the mercury influence on human fertility. Methods A systematic search was made in PubMED for papers published between 1975–2017, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Increased mercury levels were associated with infertility or subfertility status. Further, infertile subjects with unexplained infertility showed higher levels of mercury in hair, blood and urine than fertile ones. Mercury exposure induced sperm DNA damage and abnormal sperm morphology and motility. Additionally, mercury levels were related with higher incidence of menstrual and hormonal disorders and increased rates of adverse reproductive outcomes. Conclusions Our review showed that mercury negatively impacts human reproduction, affecting the reproductive and endocrine systems in both male and female. However, the molecular mechanisms underlying the mercury-associated decline on fertility remains unknown.

Made available in DSpace on 2019-10-06T16:00:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-12-01 Misoprostol is a synthetic Prostaglandin E1 (PGE1), one of the prostaglandin E (PGE) family hormones, which promotes oviduct dilatation and motility, reestablishing fertility rates in mares suspected of uterine tubal block. It is known that topical application of PGE on the surface of the uterine tubes via laparoscopic procedure improved embryo recovery and pregnancy rates in barren mares with unexplained infertility. The aim of this study was to observe if the treatment using Misoprostol could be performed via intrauterine application. Mares used in this study had been barren for at least 2 years before the treatment, without embryo or pregnancy, with a history of unexplained infertility. Thus, 22 subfertile mares, aged 5 to 26 years, were treated by a deep uterine horn application, using one Cytotec tablet (200 mcg of Misoprostol, Pfizer, USA) diluted in 3 mL of sterile water, in each horn, aiming the application as close as possible to the papilla of uterine tubes. These procedures were performed during the diestrus period, and mares were bred in the next cycle. Embryos were produced, or a pregnancy was obtained from 15 of the 22 mares within the first two cycles following Cytotec treatment. Ten of 15 mares bred as embryo donors produced embryos (0.4 embryos/cycle) in the three subsequent cycles, and six of seven mares bred to carry became pregnant after treatment. In conclusion, Misoprostol therapy can be performed via intrauterine as a potential treatment for mares with unexplained infertility, making easier and safer the treatment of these mares. Department of Animal Reproduction and Veterinary Radiology College of Veterinary Medicine and Animal Science – UNESP Department of Animal Reproduction and Veterinary Radiology College of Veterinary Medicine and Animal Science – UNESP

To analyze the effect of time intervals from the end of sperm collection to IUI on the pregnancy rates in couples who treated by COH-IUI cycles with gonadotropin due to unexplained infertility.556 couples who underwent the first COH-IUI treatment with gonadotopin due to unexplained infertility were included. Semen samples were obtained by masturbation in a private room near the laboratory on the day of insemination. For each semen samples, time between the delivery time to the laboratory and starting time of sperm washing procedure was noted as semen collection to sperm washing (SC-SW) interval, the time between the starting time of sperm washing procedure and insemination time was noted as sperm washing to insemination (SW-IUI) interval and the time between the delivery time to the laboratory and insemination was noted as semen collection to insemination (SC-IUI) interval. Clinical pregnancy was defined as positive pregnancy test followed by the presence of an intrauterine gestational sac with fetal cardiac activity by transvaginal ultrasonography at least 4 weeks after IUI.Among 556 couples, there were 84 cases of succesful clinical pregnancy and pregnancy rate was calculated as 15.1%. Intervals from SW to IUI and SC to IUI were significantly shorter in pregnant women than in non-pregnant (p0.001 and p=0.007, respectively). SW performed ≤40min after SC resulted in higher clinical pregnancy rates than did SW performed40min after SC (19.1% vs. 6.3%, respectively) (p0.001). IUI performed ≤60min after the end of SW had higher pregnancy rates (16.9%) compared to IUI performed60min after the end of SW (4.0%) (p=0.017). Likewise, IUI performed ≤90min after SC resulted in higher pregnancy rates than did IUI performed90min after SC (18.9% vs. 12.0%, respectively) (p=0.029).IUI outcome is enhanced by shorter intervals from SC to SW, from SW to IUI, and from SC to IUI in gonadotropin-IUI cycles for unexplained infertile couples.

The present study aimed to investigate the changes of endometrial progesterone and estrogen receptors in luteal phase biopsy specimens of infertile women and find a correlation, if any, between these and CD8+ receptors in the same.The study was conducted on luteal phase endometrial biopsy specimens of 30 women of unexplained infertility and 15 age matched controls. Paraffin sections were first HE stained. A standardized immunohistochemical protocol was then used to localize the estrogen, progesterone and CD8+ receptors in these samples that were expressed as percentage positivity. Unpaired T test was applied between the controls and cases both for epithelial and stromal cells. The data was also analyzed for correlation in cases for the positivity of CD8+ Cells with that of ER and PR.The positivity of estrogen receptors (ER) in stromal cells was significantly lower (p0.001) in the infertile women when compared to controls and in both the epithelial and stromal cells for progesterone receptors (p0.001). The results were non significant for CD8+ cells (p=0.19) and also showed no significant correlation in the positivity of CD8+ cells with that of ER and PR.The development of molecular probe like ER and PR positivity in endometrial epithelial and stromal cells allows a new approach to be made to the characterization of normal and defective endometrial function.

Objective: The objective of this study was to determine if different infertility diagnoses impacted patients’ scores on the FertiQol questionnaire, Insomnia Severity Index (ISI), and Perceived Stress Scale (PSS) during the COVID-19 pandemic The study also investigated if patients who were forced to discontinue their fertility treatment during the COVID-19 pandemic had different FertiQol scores than patients who were able to continue Design: Surveys were administered to 220 patients at a fertility clinic in Manhattan during the COVID-19 pandemic The surveys included a 36-item FertiQol questionnaire assessing Fertility Quality of Life in men and women experiencing fertility problems The surveys also asked patients to specify their infertility diagnoses (polycystic ovary syndrome, diminished ovarian reserve, uterine factor, endometriosis, or male infertility) Patients were further given a 7-item ISI questionnaire and a 10-item PSS questionnaire Finally, the surveys asked whether patients were forced to disrupt their fertility treatment plans due to the COVID-19 pandemic Materials and Methods: Using multiple linear regression, we looked for statistically significant relationships between different infertility diagnoses and FertiQol scores For this regression, we excluded all individuals who did not know their infertility diagnosis, had unexplained infertility issues, answered that they were fertile, or did not answer the FertiQol questionnaire We also used multiple linear regression to look for statistically significant relationships between different infertility diagnoses and levels of insomnia and between different infertility diagnoses and perceived stress Next, using Welch’s t-test, we investigated if patients who discontinued their fertility treatments during the COVID-19 pandemic had a different mean FertiQol score from patients who continued treatment We excluded all individuals who were not currently undergoing treatment and who did not answer the FertiQol questionnaire A p-value less than 0 05 was considered statistically significant Results: The majority of the IVF patients sampled self-reported moderate stress (66 9%) There was no statistically significant relationship between the exact etiology of an IVF patient’s infertility diagnosis and the patient’s FertiQol score There was also no statistically significant relationship between the exact etiology of an IVF patient’s infertility diagnosis and the patient’s ISI nor PSS scores Patients who discontinued their fertility treatments during COVID-19 did not have different FertiQol scores from patients who were able to continue Conclusions: The majority of the IVF patients sampled self-reported moderate stress during the COVID-19 pandemic Interestingly, the exact etiology of an IVF patient’s infertility diagnosis did not have a statistically significant impact upon his or her Fertility Quality of Life, ISI, and PSS scores during this time period Patients who were forced to discontinue their fertility treatments due to COVID-19 did not have different FertiQol scores from patients who were able to continue

Does delaying IVF for 6 months in couples with unexplained infertility, compared with immediate IVF treatment, decrease the cost of IVF without compromising success rates?Decision modelling was used to evaluate the cost and outcomes of immediate IVF versus delayed IVF for a cohort of women aged40 years suffering unexplained infertility. Australian data and costs were used in the analysis. For different age groups, three scenarios were tested where 10%, 50% and 90% of couples with unexplained infertility delayed IVF for 6 months if they had a good prognosis for natural conception. The study included a total of 8781 couples aged40 years, diagnosed with unexplained infertility and who had IVF in 2013.The studied couples underwent 27,648 fresh and frozen embryo transfers, for an estimated total cost of $141 million. Potential out-of-pocket cost savings if 90% of couples delayed IVF ranged from $4.7 to $12.2 million, with Medicare cost savings of up to $15.1 million. The impact on the total pregnancy and live birth rates after 18 months was minimal.In couples with unexplained infertility and a good prognosis for natural conception, delaying IVF for 6 months could substantially decrease out-of-pocket costs without compromising pregnancy and live birth rates over an 18-month period.

Intra-uterine insemination (IUI) is a cheaper, less intensive treatment modality for achieving a pregnancy in couples with specific indications. The use of IUI seems to have declined after NICE guideline 2013 (CG 156) recommended IVF over IUI in couples with unexplained and mild male factor infertility. This review examines the current evidence and the applicability of IUI as a first-line option of treatment in couples with unexplained and mild male factor subfertility. The outcome of the review supports this argument. It is likely that IUI will re-emerge as an effective treatment option and thereby increase the choice to patients. However, there is a need for ongoing research and investment into funding of good quality trials to improve and strengthen the evidence base.

Objective(s): The purpose of our study was to evaluate whether the inflammatory parameters of complete blood count (CBC), including white blood cell (WBC), neutrophil-to-lymphocyte-ratio (NLR), platelet-to-lymphocyte-ratio (PLR), and mean platelet volume (MPV), had potential roles in the etiopathogenesis of unexplained infertility (UI) among nonobese women. We also aimed to investigate whether there could be an association between these markers and in vitro fertilization (IVF) success among nonobese women with UI. Materials and methods: This was a retrospective clinical trial, including a total of 246 nonobese patients undergoing IVF procedures, 121 diagnosed as UI and 125 were age and body mass index (BMI) matched infertile controls who received IVF for tubal factor and male factor. Only normoweight (BMI

Objective The aims of this study were to examine the prevalence of Celiac disease (CD) in Canadian women with unexplained infertility versus women with an identifiable cause of infertility and to assess the sensitivity of the point-of-care Biocard Celiac Test Kit versus standard serum serologic testing. Methods In this prospective cohort study, women aged 18 to 44 who were evaluated for infertility between February 2010 and May 2012 at a tertiary academic care fertility clinic in Toronto, ON, were invited to participate. They were categorized as having unexplained infertility (Cases) or infertility secondary to a known cause (Controls). Women on a gluten-free diet or previously diagnosed with CD were excluded. Outcome measures were the Celiac Questionnaire, serum testing for tissue transglutaminase IgA antibody (anti-tTG IgA), serum IgA levels, and Biocard Celiac Test Kit. Results Of 685 women approached, 1.2% (4/326) with unexplained infertility and 1.1% (4/359) with an identifiable infertility cause were newly found to have CD. Biocard testing revealed the same results as standard serologic IgA and anti-tTG IgA testing. Conclusion CD was not more common in women with unexplained infertility than those with an identifiable cause of infertility. These results do not support the routine screening of Canadian women with infertility for CD.

Summary Background Women with unexplained infertility are often offered intrauterine insemination (IUI) with ovarian stimulation as an alternative to in-vitro fertilisation (IVF). However, little evidence exists that IUI is an effective treatment. In 2013, the UK National Institute for Health and Care Excellence recommended that IUI should not be routinely offered for couples with unexplained infertility. Methods For this pragmatic, open-label, randomised, controlled, two-centre study, we enrolled women attending two fertility clinics in New Zealand with unexplained infertility and an unfavourable prognosis of natural conception. Participants were randomly assigned (1:1) using a computer-generated randomisation sequence, prepared by an independent statistician, to either three cycles of IUI with ovarian stimulation (with either oral clomifene citrate [50–150 mg, days 2–6] or oral letrozole [2·5–7·5 mg, days 2–6], with choice of ovarian stimulation made by the clinic) or three cycles of expectant management (couples advised to be sexually active around the likely time of ovulation and provided with a diary to record the first day of each menstrual cycle and dates of sexual activity) in blocks of four, six, and ten, without stratification. The participating couple and the clinicians were informed of treatment allocation. The primary outcome was cumulative livebirth rate in the intention-to-treat population. The safety analyses were done in the intention-to-treat population. This study was prospectively registered with the Australian and New Zealand Clinical Trials Register, number ACTRN12612001025820. Findings Between March 12, 2013, and May 12, 2016, we randomly assigned 101 women to IUI with ovarian stimulation and 100 to expectant management, all of whom were included in the primary efficacy analysis and safety analyses. Women assigned to IUI had a higher cumulative livebirth rate than women assigned to expectant management (31 [31%] livebirths among 101 women vs nine [9%] livebirths among 100 women; risk ratio [RR] 3·41, 95% CI 1·71–6·79; p=0·0003). Of 31 livebirths in the IUI group, 23 resulted from IUI cycles and eight were conceived without assistance before or between IUI cycles. Of nine livebirths in the expectant management group, one patient was pregnant from IUI with ovarian stimulation at study entry and one had received off-protocol treatment (IVF). Two sets of twins were born, both in the IUI group (one from a cancelled cycle for over-response). Interpretation IUI with ovarian stimulation is a safe and effective treatment for women with unexplained infertility and an unfavourable prognosis for natural conception. Funding Auckland Medical Research Foundation, Evelyn Bond Fund of Auckland District Health Board, Mercia Barnes Trust of Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Maurice and Phyllis Paykel Trust, and The Nurture Foundation for Reproductive Research.

Background : This study was conducted to demonstrate the effectiveness and safety of herbal medicine and acupuncture treatment in unexplained infertile females. Methods : One hundred patients were recruited from 3 Korean Medicine hospitals in Korea and they voluntarily signed informed consent agreements. Participants took the Onkyeong-tang (120cc) twice daily between menstrual cycle day (MCD) 3 and 12, and herbal medicine for ovulation and implantation (120cc) twice daily between MCD 13 and 28. They also received acupuncture and moxibustion treatment during 4 menstrual cycles. After the 4 menstrual cycle treatment period, there were 3 menstrual cycle observation periods. The primary outcome is signified by clinical pregnancy rates (CPR) and the secondary outcomes were implantation rates (IR), ongoing pregnancy rates (OPR), and live birth rates. Results : 90 patients completed the study. 13 of the 90 subjects became pregnant. The CPR and IR was 14.44%. 7 of 13 pregnant subjects had continuing pregnancy for over 12 weeks, so that the OPR was 53.85%. The birth rate was 7.78%. All 7 pregnant patients gave birth to their babies and all the babies were live singletons and healthy. There were no serious adverse events. Conclusions : The findings of this study may provide the possibility of effectiveness and safety of Korea medicine treatment for unexplained infertile women. However, further study is required because of several limitations including lack of control and small sample size.

Objective To evaluate endometrial BCL6 expression as a prognostic biomarker for IVF outcome in women with unexplained infertility (UI) before ET. Design Prospective cohort study. Setting University-associated infertility clinic. Patient(s) Women with UI for >1 year. Intervention(s) We studied women with UI who underwent testing for endometrial BCL6, in an LH-timed midluteal phase biopsy and completed an IVF cycle and ET. Main Outcome Measure(s) Clinical pregnancy rate (PR) and live birth rate per transfer was compared for women positive or negative for BCL6 expression. An abnormal BCL6 result was defined by an histologic score (>1.4). Result(s) Women with normal and abnormal BCL6 and those who conceived or not had similar characteristics. Women with low levels of BCL6 expression had a significantly higher clinical PR (11/17; 64.7%; 95% confidence interval [CI] 41.3–82.6) compared with women with abnormal (high) BCL6 expression (9/52; 17.3%; 95% CI 9.3–30.8). These results yield a relative risk of 0.267 (95% CI 0.13–0.53; P =.0004) for those with normal BCL6 expression, an absolute benefit of 47.4% (95% CI 22.5–72.0). Live birth rate was also significantly higher in women with low BCL6 expression (10/17; 58.8%; 95% CI 36.0–78.4) compared with women with abnormal BCL6 expression (6/52; 11.5%; 95% CI 5.4–23.0). The relative risk was 0.19 (95% CI 0.08–0.45; P =.0002), yielding an absolute benefit of 47.3% (95% CI 21.8–67.8). Conclusion(s) Aberrant BCL6 expression (histologic score, >1.4) was strongly associated with poor reproductive outcomes in IVF cycles in women with UI.

Background Intrauterine insemination (IUI) is a first-line treatment for unexplained infertility (UI). There was a compelling need for the improvement of pregnancy rate in females with UI. Objective To explore the pregnancy predictors in cases of UI undergoing IUI. Method A total of 212 couples who underwent 446 IUI cycles were involved the study. Different factors were grouped to explore the influencing factors of IUI for UI. Result Female age and somking affected pregnancy outcomes. As the number of treatment cycles increased, the pregnancy rate increased. The BMI, treatment regimens, type of infertility, endometrium, and timing insemination have no significant prognostic value. Conclusion Apart from the number of treatment cycles, somking, and female age, no other factors had prognostic value. More studies and samples are necessary to evaluate whether other factors affect conception.

Poor uterine receptivity leads to implantation defects or failure. Identification of uterine molecules crucial to uterine receptivity and/or embryo implantation provides the opportunity to design a diagnostic screening toolkit for uterine receptivity or targeted drug discovery for treating implantation-based infertility. In this regard, gene-profiling studies performed in humans and rodents have identified numerous genes involved in the transcriptional regulation of uterine receptivity and embryo implantation. In this article, we compared available uterine microarray datasets collected during the time of uterine receptivity and implantation in humans, mice and hamsters to uncover conserved gene sets. We also compared the transcriptome signature of women with unexplained infertility (UIF) and recurrent implantation failure (RIF) to gain insight into genes potentially dysregulated during endometrial receptivity or embryo implantation. Among numerous differentially expressed genes, few were revealed that might have molecular diagnostic screening potential for identifying the uterine receptive state during the time of implantation. Finally, functional annotation of gene sets uncovered altered uterine apoptosis or cell adhesion pathways in women with UIF and RIF, respectively. These conserved or divergent gene sets provide insights into the uterine receptive state for supporting blastocyst implantation.

Objective To determine whether natural killer cell (NK) concentrations in the mid-secretory endometrial tissue of women with unexplained infertility differ from those in the mid-secretory endometrial tissue of fertile women. Methods This study was conducted with 22 patients with unexplained infertility caused by unsuccessful ovulation induced with gonadotrophins and 12 healthy fertile women, who formed a control group. Mid-secretory endometrial tissue samples were obtained with a Pipelle catheter, and the endometrial NK cell phenotypes were determined by flow cytometry. Results The median number of CD4+ cells in the endometrium was significantly lower in women with unexplained infertility compared with in the fertile controls (3.31 vs. 5.81; p=0.02). The CD4 + /CD8 + cell ratio in the unexplained-infertility group was significantly lower than that in the control group (0.42 vs. 0.76, p=0.01). The median number of CD103 + cells in the endometrium of the infertile group was significantly lower than that in the endometrium of the control group (4.40 vs. 6.73, p=0.02). The median number of CD16 + cells was significantly higher in infertile women than in control women (0.12 vs. 0.001, p=0.01). Conclusions Significant reductions in the numbers of CD4 + and CD103 + cells as well as in the CD4 + /CD8 + ratio but an increased number of CD16 + cells in the endometrium of infertile women suggest that disordered NK cell activity may be a contributor to the etiology of unexplained infertility.

Background: Ovarian reserve tests in unexplained infertility patients before management either by ovulation induction or IVF program are a worthy procedure as it saves unnecessary procedures, induction complications, canceled cycles, wasted resources and emotional stress to the couple in case of low estimate, and can as well help in adjusting the doses to obtain the most appropriate response. Aim of work: To determine the value of mean ovarian volume, AFC, maternal age, FSH and AMH in infertile patients undergoing ovulation induction or IVF cycles. Primary outcome is to predict the best parameter of ovarian reserve. Design: Prospective cross-sectional study. Patients and methods: One hundred infertile women received treatment in the form of induction of ovulation and timed intercourse/IUI or IVF. They had basal FSH, AMH, AFC and mean ovarian volume assessment. The response was then evaluated according to the number of follicles on the day of hCG or the number of oocytes retrieved in IVF cycles. Results and conclusion: The total AFC and AMH are found to correlate significantly with the ovarian response with p values

Objective: 1 – To compare the cycle pregnancy rate of intrauterine insemination (IUI) to that of intrauterine tuboperitoneal insemination (IUTPI) in unexplained infertility. 2 – To assess the effect of timing of insemination in relation to ovulation on the cycle pregnancy rate of IUI and IUTPI. Design: Prospective randomized study. Main outcome measures: 1 – Cycle pregnancy rate of IUI and IUTPI. 2 – Cycle pregnancy rate of preovulatory and postovulatory insemination. Material and methods: Two groups (A and B), each group included 160 women with unexplained primary infertility. Group A were treated by IUI and group B by IUTPI after controlled ovarian stimulation (COS) with sequential clomiphene citrate and human menopausal gonadotropin. Ovulation was by i.m. HCG. At the time of insemination the occurrence of ovulation was checked by transvaginal sonography. Results: After the first treatment cycle 17 patients of group A (10.62%) and 28 patients of group B (17.50%) had ongoing pregnancies (p = 0.0413). After the second treatment cycle 12 patients of group A (8.39%) and 18 patients of group B (19.63%) had ongoing pregnancies (p = 0.0442). After the third treatment cycle 11 patients of group A (8.39%) and 14 patients of group B (12.28%) had ongoing pregnancies (p = 0.0433). After the three treatment cycles 40 patients of group A (25%) and 60 patients of group B (37.50%) had ongoing pregnancies (p = 0.033) and the overall cycle pregnancy rate of group A was 9.21% and group B 14.81% (p = 0.0324). In group A the cycle pregnancy rate of preovulatory insemination was 7.20% and postovulatory 9.76% (p = 0.041). In group B the cycle pregnancy rate of preovulatory insemination was 17.70% and postovulatory 13.0% (p = 0.0322). Five out of 40 pregnancies (12.5%) in group A, and 4 out of 60 pregnancies (6.60%) in group B were twins (p = 0.0431). Conclusion: In unexplained primary infertility IUPI had significantly higher cycle pregnancy rate than IUI. Cycle pregnancy rate of IUI was significantly higher with postovulatory than preovulatory insemination. Cycle pregnancy rate of IUTPI was significantly higher with preovulatory than postovulatory insemination.

To examine the histological structure and vascularity of uterine septa in patients with unexplained primary infertility and patients with recurrent pregnancy loss (RPL).Case-control study (Canadian Task Force classification II-2).Kasr Al Aini Hospital, Cairo University, Egypt.A total of 41 patients with uterine septa presenting with either unexplained primary infertility or RPL underwent 3-dimensional (3D) and power Doppler (PD) ultrasound to calculate the septum volume, septal vascularization index (VI), and myometrial VI. Hysteroscopically removed septa were examined histologically for myometrial and fibrous tissue content.Septal characteristics differed between the primary infertility group (24 patients) and the RPL group (17 patients). Mean septal VI was significantly higher in the RPL group compared with the infertility group (18.39% ± 7.57% vs 11.67% ± 4.56%; p = .003), as was septal myometrial area (20.74% ± 5.97% vs 13.57% ± 5.55%; p.001). In both groups, septal VI was strongly correlated with myometrial VI and myometrial content, but not with fibrous tissue content.Uterine septa of patients with RPL are more vascularized and contain more muscular tissue compared with those of patients with primary unexplained infertility.

Objective To compare clomiphene citrate (CC) and letrozole used for superovulation before intrauterine insemination (IUI) in unexplained infertility. Design Prospective randomized trial. Setting A university teaching hospital and a private practice setting. Patient(s) Four hundred and twelve infertile women with unexplained infertility. Intervention(s) Patients were randomized to treatment with 100 mg of CC daily (207 patients, 404 cycles) or 5 mg of letrozole daily (205 patients, 400 cycles) for 5 days starting on day 3 of menses. The IUI was done 36 ± 4 hours after human chorionic gonadotropin (hCG) injection. Main Outcome Measure(s) Number of follicles, serum estradiol level, serum progesterone level, endometrial thickness, and pregnancy and miscarriage rates. Result(s) The total number of follicles during stimulation was statistically significantly greater in the CC group (3.1 ± 0.36 vs. 1.6 ± 0.41). There was no statistically significant difference in pretreatment endometrial thickness between the two groups or endometrial thickness at the time of hCG administration. Serum E 2 and progesterone concentrations were statistically significantly higher in the CC group. The days to hCG injection were similar in both groups. Pregnancy occurred in 73 out of 205 patients (400 cycles) in the letrozole group (35.6% and 18.2%, respectively) and 78 out of 207 patients (404 cycles) (37.6% and 19.3%, respectively) in the CC group; the differences were not statistically significant. Two twin pregnancies occurred in the CC group. Conclusion(s) This study found no superiority between letrozole and CC for inducing ovulation in women with unexplained infertility before IUI.

Objective: To study the prostanoid profile of the endometria of patients with recurrent implantation failure (RIF), unexplained infertility (UIF), and recurrent miscarriages (RM), and to compare them with the endometria of healthy fertile controls. Design: Prospective cohort study. Setting: University hospital. Patient(s): Fifteen patients with RIF, 18 patients with UIF, 16 patients with RM, and 23 fertile controls were recruited. Intervention(s): Endometrial samples were taken during the window of implantation. After tissue homogenization and extraction, analysis with ultra-performance liquid chromatography diode array detector electrospray ionisation tandemmass spectrometrywas performed. Main Outcome Measures: Concentrations of prostaglandin (PG) D1, PGE1, PGF1 alpha, 6-ketoPGF1 alpha GD2, PGE2, PGF2 alpha, 15-deoxy-Delta 12,14-PGJ2, PGD3, PGE3, PGF3 alpha, thromboxane B2, 13,14-dihydro-PGE1, 13,14-dihydro-PGF1 alpha, 13,14-dihydro-PGF2 alpha, 13,14dihydro-15-keto-PGE1, 13,14-dihydro-15-keto-PGE2, and 13,14-dihydro-15-keto-PGF2 alpha were assessed. Result(s): Comparison of the endometria of patients with UIF and the controls showed no statistically significant differences. When the endometria of patients with RIF were compared with the controls, thromboxane B2 (TXB2) was found significantly higher (843.1 pg/mg vs. 133.5 pg/mg). When the endometria of patients with RM were compared with controls, 13,14-dihydro-15-keto PGF2 alpha and TXB2 were found significantly higher (3907.30 pg/mg vs. 17.80 pg/mg and 858.7 pg/mg vs. 133.5 pg/mg respectively). Conclusion(s): We identified increased endometrial presence of TXB2 in patients with RM and RIF, and 13,14-dihydro-15-keto PGF2 alpha in patients with RM. Although common ground is observed for RM and RIF, prostanoids, on the other hand, might make their own contribution to endometrial receptivity as important as genes and proteins. Attempts to normalize the prostaglandin profile of the endometrium via enzymatic activity can open new therapeutic options. (C) 2019 by American Society for Reproductive Medicine.

Objective Fertiloscopy is as safe as laparoscopy in literature, but we don’t know its relevance in women with unexplained infertility (UI). Our objective was to assess the effects of fertiloscopy procedures on the outcomes of subsequent pregnancy occurrences in patients with UI. Methods Retrospective, single-center study of all patients followed up after fertiloscopy procedures between 2002 and 2007. The occurrence and outcome of pregnancies were studied in the five years following the procedure. Results 124 fertiloscopies were performed. Pelvic exploration was considered as sufficient in 83.8% of cases, of which no abnormalities were found in 78.2%. Laparoconversions occurred for 19 patients (16.5%). The pregnancy rate at five years was 76.9%. The mean delay for pregnancy occurrence was 10.7 months (±17). Conclusion The pregnancy rate in our study is similar to that after laparoscopy. Fertiloscopy, a less intrusive procedure, should be considered as a reliable option for the management of patients with UI.

Objective To compare live birth and multiple gestation in patients diagnosed with unexplained infertility undergoing intrauterine insemination after ovarian stimulation (OS-IUI) with oral medications versus gonadotropins. Design Systemic review and meta-analysis. Setting Not applicable. Patient(s) Patients undergoing OS-IUI for treatment of unexplained infertility. Intervention(s) Clomiphene, letrozole, or gonadotropins for OS-IUI. Main Outcome Measure(s) Live birth and multiple gestation. Result(s) Eight total trials were identified that met the inclusion criteria and comprised 2,989 patients undergoing 6,590 cycles. One study reported a significant increase in both live births and multiple gestations with the use of gonadotropins, two studies found an increased likelihood of live birth with the use of gonadotropins, and two studies found an increased risk of twins with gonadotropins. The relative risk of live birth in subjects receiving gonadotropins was 1.09. The relative risk of multiple gestation in subjects receiving gonadotropins was 1.06. Clinical pregnancy was higher in protocols with lax cancellation policies or higher gonadotropin doses, with subsequent increased relative risks of multiple gestations of 1.20 and 1.15, respectively. Singleton births per subject were similar between the two groups. The results did not change in per-protocol, per cycle, or fixed-effect model sensitivity analyses. Conclusion(s) For every birth gained with the use of gonadotropins, a similar increased risk of multiple gestation occurs. The randomized data do not support the use of gonadotropin for OS-IUI in women with unexplained infertility. Clinical Trial Registration Number Prospero CRD4201911998

Objective To evaluate the obstetrical outcome of pregnancies obtained after assisted reproductive technology (ART).in women with unexplained infertility. Materials and Methods We conducted a retrospective observational case - control cohort study between January 2011 and May 2017. All pregnancies obtained after ART (Intra uterine insemination, In Vitro Fertilization, Intra Cytoplasmic Sperm Injection) were included. The ART pregnancy outcome of women with unexplained infertility was compared to ART pregnancies obtained in a context of male infertility. Cases were matched to controls (1:2) for age, Body Mass Index (BMI), and smoking status. Results After exclusion of twins, we studied 67 singleton pregnancies in the case group, matched with 129 singleton pregnancies in the control group. The first-trimester complications (miscarriage before 12 weeks gestation (WG), ectopic pregnancy) were similar in the two groups. Concerning the 2nd and the 3rd trimester, the incidence of gestational diabetes mellitus, pre-eclampsia, placenta previa, preterm labor was comparable between the two groups. In singletons, we found a non-significant increase of post-partum hemorrhage (OR = 5.5, IC 0.5–50, p = 0.13) and small for gestational age new-borns (OR=3.45, IC 0.65–18.1, p = 0.14) in women with unexplained infertility. Conclusion More adverse obstetrical outcome are commonly reported after ART, even in singleton pregnancies. Little is known for explaining it and to distingue the own contributions of ART techniques and of the infertility etiology. In our study, we didn’t observe a significant negative impact of a history of unexplained infertility on pregnancy. However, further large studies are needed to evaluate more accurately the possible liabilities of the infertility etiology on obstetrical and perinatal outcome.