Unexplained Infertility

What is unexplained infertility?

It is estimated that approximately 10%-30% of couples seeking fertility treatment have unexplained infertility. This means that no identifiable cause of infertility has been found after examination of both partners, with normal fertility testing and thorough evaluation from a fertility specialist. The doctor can help explain the potential causes of fertility problems and – even if the diagnosis comes back as unexplained infertility – recommend the most appropriate treatment options.

In some cases, fertility treatments such as medications (both oral or injectable) followed by intrauterine insemination (IUI) or assisted reproductive technologies (ART) such as in vitro fertilization (IVF) are recommended to help improve the chances of pregnancy.

Causes of unexplained infertility

Some possible causes of infertility include hormonal imbalances, problems with the structure of the reproductive organs, fallopian tube issues, poor quality sperm and/or eggs, and problems with the way the sperm and eggs interact. In some cases, the cause of unexplained infertility may be a mild combination of several different factors. When all the testing is reassuring, there is at least one patent (unblocked) fallopian tube, ovarian testing is normal, and sperm function is normal, then the diagnosis of unexplained in fertility is made.

It is important to note that fertility declines with age, and the chances of conceiving naturally decrease as a woman gets older. For this reason, unexplained infertility is more common in older couples or in women who have been trying to conceive for a longer period of time, in light of normal ovarian testing.

Diagnosing this condition

Unexplained infertility is a diagnosis of exclusion, meaning that all other known causes of fertility problems have been ruled out. In order for a couple to receive this diagnosis, the woman must be ovulating regularly and have at least one open fallopian tube, while the man must have a normal semen analysis. In addition, exams of both partners must not have found any other pathology, such as uterine fibroids in the woman or structural issues in the man.

The process of diagnosing unexplained infertility typically involves the following.

• Fertility evaluation for women: This may include tests to check for ovulation, such as basal body temperature charting, luteinizing hormone (LH) urine testing (commonly known as ovulation predictor kits), and hormonal testing, as well as tests to check the health of the uterus and fallopian tubes through a pelvic ultrasound.
• Fertility evaluation for the man: This may include a semen analysis to assess the quality and quantity of sperm.
• Blood test: This can check hormone levels, such as follicle stimulating hormone (FSH), LH and estrogen.
• Imaging tests: This may include tests to assess the health and structure of the reproductive organs, such as an ultrasound, hysterosalpingogram or laparoscopy.

If no specific cause of infertility is identified after these tests, a diagnosis of unexplained infertility may be given.

Treating unexplained infertility

Unexplainable infertility does not mean untreatable. While unexplained infertility can be frustrating, there are several treatment options available that may help improve the chances of pregnancy. These depend on a variety of factors, including the couple’s age, the duration of their infertility and their personal preferences. Some common treatments for unexplained infertility include the following.

• Lifestyle changes: making healthy lifestyle choices can improve a couple’s chances of conceiving. Some specific lifestyle changes that may boost fertility include maintaining a healthy weight, stopping smoking, reducing stress and exercising.
• Ovulation induction: This involves the use of medications to stimulate the growth of eggs in the ovaries, thus improving the chance of successful fertilization and pregnancy.
• IUI: This involves placing sperm inside the uterus around the time of ovulation to increase the chances of fertilization.
• IVF: This involves retrieving eggs from the ovaries, fertilizing them in a laboratory dish with the male’s sperm, and then transferring the resulting embryo(s) back into the uterus.
• Surgery: In some cases, surgery may be recommended to rule out or repair structural abnormalities that are preventing pregnancy.

Our specialists will discuss all treatment options with patients including their personal preferences before deciding on a course of action. In some cases, a combination of treatments may be recommended to increase the chances of pregnancy.