Female Infertility

Overview

Journal BMJ Clin Evid

Specialty General Medicine

Date 2011 Mar 17

PMID 21406133

Citations 8

Authors

Siladitya Bhattacharya

Neil Johnson

Hammed Akanji Tijani

Roger Hart

Shilpi Pandey

Ahmed Fathy Gibreel

Affiliations

Soon will be listed here.

Abstract

Introduction: About 17% of couples in industrialised countries seek help for infertility, which may be caused by ovulatory failure, tubal damage or endometriosis, or a low sperm count. In developed countries, 80% to 90% of couples attempting to conceive are successful after 1 year and 95% after 2 years.

Methods And Outcomes: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for infertility caused by ovulation disorders? What are the effects of treatments for tubal infertility? What are the effects of treatments for infertility associated with endometriosis? What are the effects of treatments for unexplained infertility? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

Results: We found 55 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: clomifene; drug-induced ovarian suppression; gonadotrophin priming of oocytes before in vitro maturation; gonadotrophins; gonadotrophin-releasing hormone agonists plus gonadotrophins; gonadotrophin-releasing hormone antagonists; in vitro fertilisation; intrauterine insemination alone, or combined with gonadotrophins or clomifene; laparoscopic ablation of endometrial deposits; laparoscopic ovarian drilling; laparoscopic removal; metformin; ovarian wedge biopsy; pulsatile gonadotrophin-releasing hormone; selective salpingography plus tubal catheterisation; tamoxifen; tubal flushing; and tubal surgery before in vitro fertilisation.

Citing Articles

A disturbed communication between hypothalamic-pituitary-ovary axis and gut microbiota in female infertility: is diet to blame?.

Ahmad F, Ahmed S, Choucair F, Chouliaras S, Awwad J, Terranegra A J Transl Med. 2025; 23(1):92.

PMID: 39838491 PMC: 11749209. DOI: 10.1186/s12967-025-06117-x.

Influencing Factors of Dyadic Coping Among Infertile Women: A Path Analysis.

Tang N, Jia Y, Zhao Q, Liu H, Li J, Zhang H Front Psychiatry. 2022; 13:830039.

PMID: 35418892 PMC: 8995970. DOI: 10.3389/fpsyt.2022.830039.

Haploidy in somatic cells is induced by mature oocytes in mice.

Lee Y, Trout A, Marti-Gutierrez N, Kang S, Xie P, Mikhalchenko A Commun Biol. 2022; 5(1):95.

PMID: 35079104 PMC: 8789866. DOI: 10.1038/s42003-022-03040-5.

Human immunodeficiency: Extragonadal comorbidities of infertility in women.

Lorzadeh N, Kazemirad N, Kazemirad Y Immun Inflamm Dis. 2020; 8(3):447-457.

PMID: 32621331 PMC: 7416027. DOI: 10.1002/iid3.327.

Complementary therapy for female infertility: protocol for an overview of systematic reviews.

Lee J, Hyun M, Ang L Integr Med Res. 2020; 9(1):62-64.

PMID: 32090018 PMC: 7026274. DOI: 10.1016/j.imr.2020.01.010.

References

Brosens I, Gordts S, Valkenburg M, Puttemans P, Campo R, Gordts S . Investigation of the infertile couple: when is the appropriate time to explore female infertility?. Hum Reprod. 2004; 19(8):1689-92. DOI: 10.1093/humrep/deh314. View

Oelsner G, Sivan E, Goldenberg M, Carp H, Admon D, Mashiach S . Should lysis of adhesions be performed when in-vitro fertilization and embryo transfer are available?. Hum Reprod. 1994; 9(12):2339-41. DOI: 10.1093/oxfordjournals.humrep.a138448. View

Samsonia M, Lesnovskaia E, Kandelaki M . [Clomiphene, ovarian hyperstimulation syndrome and pregnancy]. Georgian Med News. 2009; (166):26-9. View

. Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril. 2008; 89(3):505-22. DOI: 10.1016/j.fertnstert.2007.09.041. View

Lin Y, Hwang J, Huang L, Mu S, Seow K, Chung J . Combination of FSH priming and hCG priming for in-vitro maturation of human oocytes. Hum Reprod. 2003; 18(8):1632-6. DOI: 10.1093/humrep/deg335. View

Buvat J, Marcolin G . Antiestrogens as treatment of female and male infertilities. Horm Res. 1987; 28(2-4):219-29. DOI: 10.1159/000180947. View

Griesinger G, Diedrich K, Tarlatzis B, Kolibianakis E . GnRH-antagonists in ovarian stimulation for IVF in patients with poor response to gonadotrophins, polycystic ovary syndrome, and risk of ovarian hyperstimulation: a meta-analysis. Reprod Biomed Online. 2006; 13(5):628-38. DOI: 10.1016/s1472-6483(10)60652-9. View

Palomba S, Pasquali R, Orio Jr F, Nestler J . Clomiphene citrate, metformin or both as first-step approach in treating anovulatory infertility in patients with polycystic ovary syndrome (PCOS): a systematic review of head-to-head randomized controlled studies and meta-analysis. Clin Endocrinol (Oxf). 2008; 70(2):311-21. DOI: 10.1111/j.1365-2265.2008.03369.x. View

de Mouzon J, Goossens V, Bhattacharya S, Castilla J, Ferraretti A, Korsak V . Assisted reproductive technology in Europe, 2006: results generated from European registers by ESHRE. Hum Reprod. 2010; 25(8):1851-62. DOI: 10.1093/humrep/deq124. View

10.

Thurmond A . Pregnancies after selective salpingography and tubal recanalization. Radiology. 1994; 190(1):11-3. DOI: 10.1148/radiology.190.1.8259385. View

11.

Elizur S, Tulandi T . Drugs in infertility and fetal safety. Fertil Steril. 2008; 89(6):1595-602. DOI: 10.1016/j.fertnstert.2008.02.092. View

12.

Rossing M, Daling J, Weiss N, Moore D, Self S . Ovarian tumors in a cohort of infertile women. N Engl J Med. 1994; 331(12):771-6. DOI: 10.1056/NEJM199409223311204. View

13.

Moll E, van der Veen F, van Wely M . The role of metformin in polycystic ovary syndrome: a systematic review. Hum Reprod Update. 2007; 13(6):527-37. DOI: 10.1093/humupd/dmm026. View

14.

Liu J, Larsen U, Wyshak G . Prevalence of primary infertility in China: in-depth analysis of infertility differentials in three minority province/autonomous regions. J Biosoc Sci. 2005; 37(1):55-74. DOI: 10.1017/s0021932003006461. View

15.

Bhattacharya S, Hamilton M, Shaaban M, Khalaf Y, Seddler M, Ghobara T . Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: a randomised controlled trial. Lancet. 2001; 357(9274):2075-9. DOI: 10.1016/s0140-6736(00)05179-5. View

16.

Gillett W, Clarke R, Herbison G . First and subsequent pregnancies after tubal microsurgery: evaluation of the fertility index. Fertil Steril. 1998; 68(6):1033-42. DOI: 10.1016/s0015-0282(97)00396-8. View

17.

Whittemore A, Harris R, Itnyre J . Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol. 1992; 136(10):1184-203. DOI: 10.1093/oxfordjournals.aje.a116427. View

18.

Cohlen B, Te Velde E, Looman C, Eijckemans R, Habbema J . Crossover or parallel design in infertility trials? The discussion continues. Fertil Steril. 1998; 70(1):40-5. DOI: 10.1016/s0015-0282(98)00114-9. View

19.

Sallam H, Garcia-Velasco J, Dias S, Arici A . Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev. 2006; (1):CD004635. PMC: 8195082. DOI: 10.1002/14651858.CD004635.pub2. View

20.

Kontoravdis A, Makrakis E, Pantos K, Botsis D, Deligeoroglou E, Creatsas G . Proximal tubal occlusion and salpingectomy result in similar improvement in in vitro fertilization outcome in patients with hydrosalpinx. Fertil Steril. 2006; 86(6):1642-9. DOI: 10.1016/j.fertnstert.2006.05.032. View