Guideline

Australian Evidence-based Guideline for unexplained infertility

About 30% of infertile heterosexual couples are considered affected by 'unexplained infertility' (UI). This controversial diagnosis is made when no abnormalities of the female and male reproductive systems are identified. UI is inevitably a diagnosis by exclusion after 'standard' investigations. However, a real standardisation of the diagnostic workup is still lacking.

The proportion of couples with UI is related to the extent of diagnostic examinations performed to uncover putative causes for unsuccessful attempts at pregnancy (ESHRE Capri Workshop Group, 2004). Furthermore, the criteria for labelling specific features as 'normal' are heterogeneous. Finally, apart from the clearly recognised causes of infertility, several undetectable defects in the reproductive process might prevent conception. The management of UI is likewise traditionally empirical. The efficacy, safety, costs and risks of treatment options have not been subjected to robust evaluation.

The ESHRE Special Interest Group (SIG) Reproductive Endocrinology initiated the development of an ESHRE guideline focussing on the diagnosis and the therapeutic management of couples with UI. The guideline was developed according to a well-documented methodology that is universal to ESHRE guidelines and described in the Manual for ESHRE guideline development.

The ESHRE guideline development group (GDG) was comprised of members of the SIG Reproductive Endocrinology, SIG Andrology, SIG Safety and Quality in Assisted Reproductive Technologies (ART), SIG nurses and midwives, and a patient representative from Fertility Europe. This guideline was developed in collaboration with The Centre for Research Excellence in Women’s Health in Reproductive Life (CRE WHiRL), funded by The Australian National Health and Medical Research Council (NHMRC) and administered by Monash University, including Australian Representatives throughout the process.

The Centre for Research Excellence in Women’s Health in Reproductive Life (CRE WHiRL) undertook to adapt the ESHRE Guideline for the Australian context using the ADAPTE process and to seek approval to endorse that the guidelines meet the NHMRC standard for clinical practice guidelines. This document combines the ESHRE evidence and Australian-adapted content and recommendations. Methods used to adapt this guideline align with international best practices and follow comprehensive, evidence-based guideline development processes and criteria, including ADAPTE, the Appraisal of Guidelines for REsearch & Evaluation (AGREE II), the Australian NHMRC and ESHRE evidence-based guideline development methods.

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