O-203 Unexplained infertility: diagnosis by exclusion

Abstract Study question: What is the optimal work-up to establish the diagnosis of unexplained infertility, based on the best available evidence in the literature? Summary answer: The ESHRE Guideline on Unexplained Infertility provides 35 recommendations on the diagnosis of unexplained infertility. What is known already? The diagnosis of unexplained infertility is made when no abnormalities of the female and/or male reproductive systems are clearly identified. UI is inevitably a diagnosis by exclusion, after “standard” investigations. However, a real standardization of the diagnostic work-up is still lacking. Study design, size, duration: The guideline was developed according to the structured methodology for the development of ESHRE guidelines. First, a group of experts formulated the key questions. Literature searches and assessments were then performed. Papers written in English and published up to 24 October 2022 were included in the review. Prior to publication, the guideline was reviewed by independent international reviewers. Participants/materials, setting, methods: Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. A stakeholders’ review was organized after the finalization of the draft. The revised version was approved by the guideline group and the ESHRE Executive Committee. Main results and the role of chance: This guideline aims to help clinicians in delivering the optimal care for couples with unexplained infertility. Since unexplained infertility is a diagnosis of exclusion, this lecture will focus on the diagnostic procedures that couples should/could go through during the infertility work-up, and will analyse the need for additional diagnostic tests to establish the diagnosis of unexplained infertility. The guideline has been in stakeholder review and is prepared for submission in 2023. Limitations, reasons for caution: Most diagnostic tests and interventions in couples with unexplained infertility are not well studied. For a large proportion of these tests, evidence was very limited and of very low quality. Further studies are definitely needed in this field, possibly providing reliable data for revisiting the current recommendations. Wider implications of the findings: Based on the best available evidence, the guideline provides clinicians with clear advice on how to optimize the diagnostic approach to couples with unexplained infertility. In addition, a list of research recommendations is included to prompt further studies in the field. Study funding/competing interest(s) The guideline was developed and funded by ESHRE, that covered expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not