Expectant Management Of Unexplained Infertility:A Systematic Review And Meta-analysis

Objective: The purpose of this study was to evaluate the expectant treatment for unexplained infertility patients by systematic evaluation and meta-analysis.The following four aspects are discussed for evaluating the effectiveness and safety ofunexplained infertility patients so that providing reference for clinical treatment :(1)comparing expectant treatment and laparoscopic surgery;(2)comparing expectant treatment and ovulation induction;(3)comparing expectant treatment and unstimulated intrauterine insemination(IUI);(4)comparing expectant treatment and in vitro fertilisation and embryo transfer(IVF-ET).Methods: Several different electronic databases including CBM?WanFang Data?Pubmed?Embase?CNKI?CBM from incepyion to March 1st 2018?Results:Nine eligible studies involving 2475 patients varied from 2 cohort studies and 7 randomized controlled trials(RCTs)were include.The results of meta-analysis indicated that:When the unexplained infertility female duration of infertility less than 2 years and follow-up time of one year and above,the clinical pregnancy rate of expectation treatment was higher than active clinical therapy,and there was no statistically difference[RR=1.37,95%CI(0.65,2.89),P=0.41].Comiphene citrate offered no better live-birth rates than expectant management,and there was no statistically difference[RR=1.22,95%CI(0.76,1.97),P=0.41].Ongoing pregnancy rate of expectant management was higher than active clinical therapy,and there was no statistically difference [RR=1.14,95%CI(0.91,1.44),P=0.27];For the rate of multiple pregnancy,OI+IUI was higher than expectant management,and there was no statistically difference [RR=0.57,95%CI(0.09,3.59),P=0.55];The group of OI+IUI and IVF occurred ovarian hyperstimulation syndrome(OHSS),and there was statistically difference [RR=0.11,95%CI(0.01,0.86),P=0.04]?Conclusions: The current data indicates that for the treatment of unexplained infertility,there is no strong evidence for evaluating effectiveness between expectant management and laparoscopic surgery.Compared with expectant treatment,oral CC ovulation and IUI in the natural cycle were not more effective for UI patients who were young,and had longer duration infertity.However,OI combined with IUI and IVF-ET were more effective than expectant management,but also with a certain number of pregnancy and OHSS risks.