Expectant management

 

Chances of spontaneous conception remain high in couples with unexplained subfertility. In a multicentre cohort study with 437 couples with unexplained subfertility, 74% couples conceived spontaneously [Ref].  A Dutch multicentre trial randomised 253 couples with unexplained subfertility and intermediate prognosis of natural conception within 12 months, into expectant management and intrauterine insemination with controlled ovarian hyperstimulation for 6 months. They showed similar ongoing pregnancy rates between the two groups (23% for the intervention group and 27% for the expectant management group) [Ref] and a saving of €2616 per couple in favour of expectant management[Ref]. Though expectant management is a valid option for couples with favourable prognosis, it remains challenging for the clinicians to decide the best candidate for this treatment. Various prediction models have been developed to help clinicians in this regard. There are 29 such prediction models. However, they are developed for different patient profiles and lack thorough external validation[Ref]. Though these models can be used for decision making in couples similar to the population it was developed for, there remain concerns regarding their generalisability across different patient profiles. On the other hand, expectant management might not be acceptable to many couples as further attempts of natural conception add to already existing stress and frustration[Ref ]. This leads to overtreatment in many of these cases[Ref].