Esterilidad de origen desconocido: la inseminación artificial como primer tratamiento

Objective: The main objective of the study is to know the gestation rate of artificial inseminations (AI) and in vitro fertilization (IVF) in couples with a diagnosis of unexplained infertility. As secondary objectives, it is intended to study and analyze possible predictors of insemination failure. Material and methods: Retrospective cohort study in which all inseminations performed in couples diagnosed with unexplained infertility were included, between January 2008 and December 2019. Results: The pregnancy rate per cycle in AI was 13% with a cumulative rate 30.6%. The cumulative pregnancy rate decreased with successive insemination cycles (p <0.000). No predictive factor has been detected in this group of patients to assess the need for an in vitro technique. In women who subsequently underwent IVF due to unsuccessful AI, the cumulative pregnancy rate per cycle, including fresh and vitrified transfers, was 44.2%. When the characteristics of the IVF cycles were compared between the patients who became pregnant and those who did not, it was observed that the dose of rFSH was higher in the group that achieved pregnancy (p = 0.01) as well as the dose of HMGu (p = 0.022). Conclusions: It has not been possible to establish some predictive factors to know the failure of inseminations in these couples and the need to continue with in vitro techniques. Therefore, the management of couples diagnosed with unexplained infertility must be personalized and individualized.