S. J. Dyer, International estimates on infertility prevalence and treatment seeking: potential need and demand for medical care, Hum Reprod, vol.24, issue.9, pp.2379-80, 2009.

S. Gurunath, Z. Pandian, R. A. Anderson, and S. Bhattacharya, Defining infertility--a systematic review of prevalence studies. Hum Reprod Update, vol.17, pp.575-88, 2011.

J. L. Evers, Female subfertility. The Lancet, Jul, vol.13, issue.9327, pp.151-160, 2002.

, Practice Committee of American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion, Fertil Steril, vol.99, issue.1, p.63, 2013.

P. G. Crosignani and B. L. Rubin, Optimal use of infertility diagnostic tests and treatments. The ESHRE Capri Workshop Group, Hum Reprod, vol.15, issue.3, pp.723-755, 2000.

T. A. Gelbaya, N. Potdar, Y. B. Jeve, and L. G. Nardo, Definition and epidemiology of unexplained infertility, Obstet Gynecol Surv, vol.69, issue.2, pp.109-124, 2014.

, Journal de Gynécologie Obstétrique et Biologie de la Reproduction, vol.34, p.513, 2005.

, Practice Committee of the American Society for Reproductive Medicine. Effectiveness and treatment for unexplained infertility, Fertil Steril, vol.86, issue.5, pp.111-114, 2006.

A. J. Goverde, J. Mcdonnell, J. P. Vermeiden, R. Schats, F. F. Rutten et al., Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis, Lancet, vol.355, issue.9197, pp.13-21, 2000.

P. Steures, J. W. Van-der-steeg, P. Hompes, J. Habbema, M. Eijkemans et al., Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial, Lancet, vol.368, issue.9531, pp.216-237, 2006.

A. A. Te-pleto, I. D. Cooke, and O. Pms, Evide e-based Fertility Treatment, 1998.

D. Guzick, M. Sullivan, G. D. Adamson, M. Cedars, R. Falk et al., Efficacy of treatment for unexplained infertility, Fertility and Sterility, vol.70, issue.2, pp.207-220, 1998.

M. Aboulghar, R. Mansour, G. Serour, A. Abdrazek, Y. Amin et al., Controlled ovarian hyperstimulation and intrauterine insemination for treatment of unexplained infertility should be limited to a maximum of three trials, Fertil Steril, vol.75, issue.1, pp.88-91, 2001.

S. M. Veltman-verhulst, E. Hughes, R. O. Ayeleke, and B. J. Cohlen, Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev, vol.2, 2016.

S. Bhattacharya, K. Harrild, J. Mollison, S. Wordsworth, C. Tay et al., Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial, BMJ, pp.337-716, 2008.

J. A. Collins, E. A. Burrows, and A. R. Wilan, The prognosis for live birth among untreated infertile couples, Fertil Steril, vol.64, issue.1, pp.22-30, 1995.

H. K. Snick, T. S. Snick, J. L. Evers, and J. A. Collins, The spontaneous pregnancy prognosis in untreated subfertile couples: the Walcheren primary care study, Hum Reprod, vol.12, issue.7, pp.1582-1590, 1997.

A. Nandi, P. Bhide, R. Hooper, A. Gudi, A. Shah et al., Intrauterine insemination with gonadotropin stimulation or in vitro fertilization for the treatment of unexplained subfertility: a randomized controlled trial, Fertil Steril, vol.107, issue.6, pp.1329-1335, 2017.

I. M. Custers, T. E. König, F. J. Broekmans, P. Hompes, E. Kaaijk et al., Couples with unexplained subfertility and unfavorable prognosis: a randomized pilot trial comparing the effectiveness of in vitro fertilization with elective single embryo transfer versus intrauterine insemination with controlled ovarian stimulation, Fertil Steril, vol.96, issue.5, pp.1107-1111, 2011.

R. H. Reindollar, M. M. Regan, P. J. Neumann, B. Levine, K. L. Thornton et al., A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial, Fertil Steril, vol.94, issue.3, pp.888-99, 2010.

, Fertility problems: assessment and treatment | Guidance and guidelines | NICE, vol.21, 2018.

P. J. Taylor and J. A. Collins, Unexplained infertility, vol.304, 1992.

A. J. Bensdorp, R. Tjon-kon-fat, H. Verhoeve, C. Koks, P. Hompes et al., Dropout rates in couples undergoing in vitro fertilization and intrauterine insemination, Eur J Obstet Gynecol Reprod Biol, vol.205, pp.66-71, 2016.

L. L. Veeck, Atlas of the Human Oocyte and Early Conceptus, Pre-embryo grading, pp.121-149

, Collège National des Gynécologues et Obstétriciens Français (CNGOF) Extrait des mises à jour en gynécologie et obstétrique (guidelines), vol.39, pp.113-121, 2010.

E. G. Hughes, M. L. Beecroft, V. Wilkie, L. Burville, P. Claman et al., A multicentre randomized controlled trial of expectant management versus IVF in women with Fallopian tube patency, Hum Reprod, vol.19, issue.5, pp.1105-1114, 2004.

Z. Pandian, A. Gibreel, and S. Bhattacharya, In vitro fertilisation for unexplained subfertility. Cochrane Database Syst Rev, 2015.

S. Soliman, S. Daya, J. Collins, and J. Jarrell, A randomized trial of in vitro fertilization versus conventional treatment for infertility, Fertility and Sterility, vol.59, issue.6, pp.1239-1283, 1993.

A. J. Bensdorp, R. I. Tjon-kon-fat, P. Bossuyt, C. Koks, .. M. Oosterhuis et al., Prevention of multiple pregnancies in couples with unexplained or mild male subfertility: randomised controlled trial of in vitro fertilisation with single embryo transfer or in vitro fertilisation in modified natural cycle compared with intrauterine insemination with controlled ovarian hyperstimulation, BMJ, pp.350-7771, 2009.

M. B. Goldman, K. L. Thornton, D. Ryley, M. M. Alper, J. L. Fung et al., A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T), Fertil Steril, vol.101, issue.6, pp.1574-1581, 2014.

D. S. Guzick, S. A. Carson, C. Coutifaris, J. W. Overstreet, P. Factor-litvak et al., Efficacy of Superovulation and Intrauterine Insemination in the Treatment of Infertility, New England Journal of Medicine, vol.340, issue.3, pp.177-83, 1999.

M. P. Diamond, R. S. Legro, C. Coutifaris, R. Alvero, R. D. Robinson et al., Gonadotropin, or Clomiphene for Unexplained Infertility, N Engl J Med, vol.373, issue.13, pp.1230-1270, 2015.

F. Guerif, M. H. Saussereau, C. Barthelemy, M. L. Couet, O. Gervereau et al., Efficacy of IVF using frozen donor semen in cases of previously failed DI cycles compared with tubal infertility: a cohort study, Reprod Biomed Online, vol.9, issue.4, pp.404-412, 2004.

S. C. Foo-g, J. A. Fleetha, J. A. Kea-e, S. G. Ott, S. C. Tough et al., A p ospe tive a do ized t ial of conventional in vitro fertilization versus intracytoplasmic sperm injection in unexplained infertility, J Assist Reprod Genet, vol.23, issue.3, pp.137-177, 2006.

A. De and B. ,

D. J. Mclernon, E. W. Steyerberg, E. R. Velde, . Te, A. J. Lee et al., Predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation: population based study of linked cycle data from 113 873 women, BMJ, pp.355-5735, 2016.

J. A. Leijdekkers, M. Eijkemans, T. C. Van-tilborg, S. C. Oudshoorn, D. J. Mclernon et al., Predicting the cumulative chance of live birth over multiple complete cycles of in vitro fertilization: an external validation study, Hum Reprod, vol.33, issue.9, pp.1684-95, 2018.

A. Smith, K. Tilling, S. M. Nelson, and D. A. Lawlor, Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles, JAMA, vol.314, issue.24, pp.2654-62, 2015.

B. A. Malizia, M. R. Hacker, and A. S. Penzias, Cumulative Live-Birth Rates after In Vitro Fertilization, New England Journal of Medicine, vol.360, issue.3, pp.236-279, 2009.

J. Fukuda, J. Kumagai, H. Kodama, M. Murata, K. Kawamura et al., Upper limit of the number of IVF-ET treatment cycles in different age groups, predicted by cumulative take-home baby rate, Acta Obstetricia et Gynecologica Scandinavica, vol.80, issue.1, pp.71-74, 2001.

S. Ebrard-charra, L. Reyftmann, B. Hédon, and H. Déchaud,

, Gynecol Obstet Fertil, vol.33, issue.10, pp.762-769, 2005.

J. L. Frattarelli, A. J. Levi, B. T. Miller, and J. H. Segars, A prospective assessment of the predictive value of basal antral follicles in in vitro fertilization cycles, Fertil Steril, vol.80, issue.2, pp.350-355, 2003.

M. Erdem, A. Erdem, I. Guler, and S. Atmaca, Role of antral follicle count in controlled ovarian hyperstimulation and intrauterine insemination cycles in patients with unexplained subfertility, Fertil Steril, vol.90, issue.2, pp.360-366, 2008.

A. Erdem, M. Erdem, S. Atmaca, U. Korucuoglu, and O. Karabacak, Factors affecting live birth rate in intrauterine insemination cycles with recombinant gonadotrophin stimulation, Reprod Biomed Online, vol.17, issue.2, pp.199-206, 2008.

R. I. Tjon-kon-fat, P. Tajik, M. H. Zafarmand, A. J. Bensdorp, P. Bossuyt et al., IVF or IUI as first-line treatment in unexplained subfertility: the conundrum of treatment selection markers, Hum Reprod, vol.32, issue.5, pp.1028-1060, 201701.

L. Johnson, I. E. Sasson, M. D. Sammel, and A. Dokras, Does intracytoplasmic sperm injection improve the fertilization rate and decrease the total fertilization failure rate in couples with well-defined unexplained infertility? A systematic review and meta-analysis, Fertil Steril, vol.100, issue.3, pp.704-715, 2013.

F. Khamsi, Y. Yavas, S. Roberge, J. C. Wong, I. C. Lacanna et al., Intracytoplasmic sperm injection increased fertilization and good-quality embryo formation in patients with non-male factor indications for in vitro fertilization: a prospective randomized study, Fertil Steril, vol.75, issue.2, pp.342-349, 2001.

S. Bhattacharya, M. Hamilton, M. Shaaban, Y. Khalaf, M. Seddler et al., Conventional invitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: a randomised controlled trial. The Lancet, vol.357, pp.2075-2084, 2001.

C. S. Siristatidis, A. Gibreel, G. Basios, A. Maheshwari, and S. Bhattacharya, Gonadotrophin-releasing hormone agonist protocols for pituitary suppression in assisted reproduction. Cochrane Database Syst Rev, 2009.

J. Xiao, C. Su, and X. Zeng, Comparisons of GnRH antagonist versus GnRH agonist protocol in supposed normal ovarian responders undergoing IVF: a systematic review and meta-analysis, PLoS ONE, vol.9, issue.9, 2014.

R. Wang, S. Lin, Y. Wang, W. Qian, and L. Zhou, Comparisons of GnRH antagonist protocol versus GnRH agonist long protocol in patients with normal ovarian reserve: A systematic review and metaanalysis, PLoS ONE, vol.12, issue.4, 2017.

M. Niinimäki, Z. Veleva, and H. Martikainen, Embryo quality is the main factor affecting cumulative live birth rate after elective single embryo transfer in fresh stimulation cycles, Eur J Obstet Gynecol Reprod Biol, vol.194, pp.131-136, 2015.

N. Gatimel, M. Ladj, C. Teston, F. Lesourd, C. Fajau et al., How many embryos should be transferred? A validated score to predict ongoing implantation rate, European Journal of Obstetrics & Gynecology and Reproductive Biology, vol.212, pp.30-36, 2017.

C. C. Hunault, M. Eijkemans, M. Pieters, E. R. Te-velde, J. Habbema et al., A prediction model for selecting patients undergoing in vitro fertilization for elective single embryo transfer, Fertil Steril, vol.77, issue.4, pp.725-757, 2002.

A. Strandell, C. Bergh, and K. Lundin, Selection of patients suitable for one-embryo transfer may reduce the rate of multiple births by half without impairment of overall birth rates, Hum Reprod, vol.15, issue.12, pp.2520-2525, 2000.

L. Ottosen, U. Kesmodel, J. Hindkjaer, and H. J. Ingerslev, Pregnancy prediction models and eSET criteria for IVF patients--do we need more information?, J Assist Reprod Genet, vol.24, issue.1, pp.29-36, 2007.

A. Hassan, M. Kotb, A. Awadallah, A. Wahba, and N. Shehata, Follicular output rate can predict clinical pregnancy in women with unexplained infertility undergoing IVF/ICSI: a prospective cohort study, Reprod Biomed Online, vol.34, issue.6, pp.598-604, 2017.

M. Brandes, J. Van-der-steen, S. B. Bokdam, C. Hamilton, J. P. De-bruin et al., When and why do subfertile couples discontinue their fertility care? A longitudinal cohort study in a secondary care subfertility population, Hum Reprod, vol.24, issue.12, pp.3127-3162, 2009.

I. M. Custers, T. Van-dessel, P. A. Flierman, P. Steures, M. Van-wely et al., Couples dropping out of a reimbursed intrauterine insemination program: what is their prognostic profile and why do they drop out?, Fertility and Sterility, vol.99, issue.5, pp.1294-1302, 2013.

U. Van-den-broe-k, L. Holvoet, P. Bakela-ts, E. De-tte-ae-e, K. et al., 'easo s fo dropout in infertility treatment, Gynecol Obstet Invest, vol.68, issue.1, pp.58-64, 2009.

S. Gameiro, J. Boivin, L. Peronace, and C. M. Verhaak, Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment, Hum Reprod Update, vol.18, issue.6, pp.652-69, 2012.

M. Verberg, M. Eijkemans, E. Heijnen, F. J. Broekmans, C. De-klerk et al., Why do couples drop-out from IVF treatment? A prospective cohort study, Hum Reprod, vol.23, issue.9, pp.2050-2055, 2008.

J. Cwikel, Y. Gidron, and E. Sheiner, Psychological interactions with infertility among women, Eur J Obstet Gynecol Reprod Biol, vol.117, issue.2, pp.126-157, 2004.

H. Klonoff-cohen, C. E. Natarajan, L. Sieber, and W. , A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer, Fertil Steril, vol.76, issue.4, pp.675-87, 2001.

A. Eugster and A. J. Vingerhoets, Psychological aspects of in vitro fertilization: a review, Soc Sci Med, vol.48, issue.5, pp.575-89, 1999.

C. Olivius, B. Friden, G. Borg, and C. Bergh, Why do couples discontinue in vitro fertilization treatment? A cohort study, Fertil Steril, vol.81, issue.2, pp.258-61, 2004.

A. Van-dongen, T. Verhagen, J. Dumoulin, J. A. Land, and J. Evers, Reasons for dropping out from a waiting list for in vitro fertilization, Fertil Steril, vol.94, issue.5, pp.1713-1719, 2010.

J. Boivin, A. D. Domar, D. B. Shapiro, T. H. Wischmann, B. Fauser et al., Tackling burden in ART: an integrated approach for medical staff, Hum Reprod, vol.27, issue.4, pp.941-50, 2012.

. Deville-marie, Devenir des couples en infertilité inexpliquée après échec des inséminations intra-utérines. 58 feuilles, 4 illustrations graphiques., 9 tableaux, 30 cm

. N° and . Résumé, Rennes, 2018.

, La prise en charge recommandée est de réaliser 4 à 6 cycles d'inséminations intra-utérine (IIU), puis de poursuivre en cas d'échec par des fécondations invitro (FIV). Le parcours peut être long et éprouvant et beaucoup abandonne en cours de traitement L'objectif de cette étude est d, L'infertilité inexpliquée est caractérisée par un bilan du couple ne permettant pas d'expliquer le délai de conception

, Les couples inclus présentaient une infertilité inexpliquée et bénéficiaient d'IIU puis de FIV si échec. Le critère de jugement principal était la naissance vivante, Nous avons réalisé une étude rétrospective monocentrique entre février 2008 et décembre, 2014.

, Le taux de naissances vivantes par couple en FIV était de 58,2% après une moyenne de 1,4 tentatives. Le nombre d'embryons de bonne qualité étaient significativement plus important dans le groupe obtenant une naissance vivante en FIV (6,04 +/-3,49 versus 3,68 +/-3,15 p=0,001), confirmé sur le modèle après sélection de variables, Sur les 251 couples inclus, 80 ont obtenu une naissance vivante en IIU, 91 ont été pris en charge en FIV et 80 couples ont été perdus de vue, vol.36, p.0

, Le nombre d'embryons de bonne qualité obtenus est un facteur prédictif de réussite en FIV, Un compte des follicules antraux élevé est un facteur prédictif de grossesse en IIU versus FIV

, The included couples had unexplained infertility and got intrauterine inseminations with gonadotropin stimulation and in-vitro fertilization if no live birth was obtained. The main judgement criterion was live birth. Lost to follow-up couples were contacted by questionnaires. Of the 251 included couples, 80 obtained live birth with IUI, 91 underwent IVF and 80 couples were lost to follow-up, The recommended process is to perform 4 to 6 cycles of intrauterine inseminations (IUI), then to continue in case of failure by in-vitro fertilization (IVF), 2008.

, Rubrique de classement : Epidémiologique Mots-clés : Infertilité inexpliquée, inséminations intra-utérine, A high antral follicle count is a predictor of pregnancy in IUI versus IVF

. Mots-clés-anglais-mesh, Unexplained infertility, intrauterine insemination, in vitro fertilization, drop out, predictive factors, live birth JURY: Président : Pr Levêque Jean, PU-PH, service de Gynécologie et Obstétrique, et Reproduction Humaine Assesseurs : Dr Duros Solène, PHC

P. Vincent,

C. Pr-ravel,