Unexplained Infertility

• Overview: Our fertility specialists diagnose unexplained infertility in about 30% of couples when standard infertility testing has not determined a cause for their difficulty in becoming pregnant.
• Causes: Unexplained infertility causes are unknown by definition but involve conditions that separately or in combination result in diminished or delayed fertility in either or both partners.
• Diagnosis: The Fertility Institute follows established guidelines on fertility testing and only arrives at a diagnosis of unexplained infertility when testing fails to detect an underlying reason for infertility.
• Treatments: The good news is that unexplained infertility does not mean untreatable, and we offer several treatment options including medication therapy, intrauterine insemination (IUI) and in vitro fertilization (IVF), which is the most successful.

What is unexplained infertility?

Unexplained infertility, sometimes called idiopathic infertility, is the default diagnosis when a standard infertility evaluation has not determined a cause for the individual or couple’s inability to become pregnant. According to the American Society for Reproductive Medicine (ASRM), this occurs in up to 30% of fertility patients.

We take even the toughest cases, including patients who weren’t successful or were turned down at other clinics. Please make an appointment if you think we can help.

Unexplained infertility diagnosis after infertility testing

In these cases, standard diagnostic testing shows nothing appears to be wrong with the man’s sperm, or the woman’s fallopian tubes, uterus, ovaries or her ovulatory function. This testing generally can identify the major reasons why a couple is experiencing infertility – either male infertility, female infertility or a mixture of both factors.

However, infertility testing may not be able to detect all the subtle and small variations in one or more fertility factors that can ultimately combine or compound to cause infertility.

Causes of unexplained infertility

In reality, there are many “causes” of infertility. Diagnostic testing will reveal many obvious factors of infertility, such as blocked fallopian tubes, abnormal sperm counts and ovulation problems. But it may not address more subtle infertility factors such as inadequate egg quality, problems with embryo development or embryo implantation issues.

Possible factors that can cause infertility, poor fertility or delayed fertility and lead to an unexplained infertility diagnosis include:

• Abnormalities or disruptions in the woman’s luteal phase, the stage in the menstrual cycle that occurs after ovulation and relates to progesterone production.
• Subtle abnormalities in the uterus or ovaries.
• Release of an egg before it is mature, thereby not able to be fertilized.
• The couple’s or individual’s lack of understanding about the importance of timing intercourse around predicted ovulation and of having intercourse frequently enough to increase the chances of pregnancy. Jump to lifestyle factors section.

Arriving at a diagnosis of unexplained infertility

We follow ASRM guidelines in the steps we take before making a diagnosis of unexplained infertility.

• First, our providers meet with the couple (or individual) to discuss the medical, surgical and sexual history of both partners. Typically, there is no exam performed at this first visit.
• If needed, we will perform a physical exam on the female patient, looking for structural issues and other indicators of reproductive system problems.
• We test for female infertility due to ovulation issues through the use of ovulation predictor kits and timed blood tests that detect important reproductive hormones. We may also utilize an ultrasound exam of the ovaries.
• The doctor may recommend an X-ray test of the fallopian tubes and uterus (called a hysterosalpingogram) that uses a radiographic dye solution to help image the tubes and uterine cavity.
• To test for male infertility, we perform a semen analysis that provides information about the sperm count, the sperm movement and the sperm shapes.

If none of the above gives us an indication of the cause of infertility, we will likely diagnose unexplained infertility and discuss treatment options.

Treatments for unexplained infertility

Once we’ve arrived at a diagnosis of unexplained infertility, we work with the couple or individual to create the best treatment plan, going from the simplest treatment options to the more complex. This diagnosis means our specialists must use their judgment, experience and clinical observations to arrive at the best suggested solution.

Treatment plans as unique as you

Our doctors understand one size does not fit all when it comes to treatment.

At The Fertility Institute we don’t immediately push in vitro fertilization (IVF) when it’s not necessary. Often unexplained infertility can be overcome with simple and low-cost treatments.

Due to the unknown nature of the reason for infertility, our specialists generally discuss a planned time limit for certain treatments with patients. Typically we will try one approach for two or three cycles of treatment and then evaluate next steps if it hasn’t worked. Then we will discuss moving to other options or combinations.

Unexplained infertility is often treated with ovulation induction, intrauterine insemination (IUI) or simple lifestyle changes. However, IVF is sometimes the best option.

Ovulation induction through fertility medication

Medications such as clomid or letrozole can be used to induce the ovaries to produce one or more egg(s) during the menstrual cycle. This increases the chance of an egg becoming fertilized and the woman becoming pregnant. This is often used along with IUI or improving the timing of intercourse.

Depending on the woman’s individual situation, we may use gonadotropin therapy. These injections of pituitary hormones can assist with egg development in patients who do not respond to oral medication or who have failed to conceive on oral medications alone. In these ovulation assisted cycles, human Chorionic Gonadotropin (hCG) is often used to trigger the release of the mature eggs.

Intrauterine insemination (IUI)

With IUI, prewashed sperm are placed directly into the woman’s uterus using a catheter that travels through the vagina and cervix into the uterus. This increases the number of sperm that can reach the top of the uterus and move into the fallopian tubes where the egg is located and fertilization occurs.

In vitro fertilization (IVF)

IVF will sometimes reveal subtle infertility factors that diagnostic processes miss such as inadequate egg quality, poor embryo development or embryo implantation issues. Sometimes women with excellent ovarian reserve can still have poor egg quality.

The average success rate of IVF is very impressive. For women under 35 years old, 47.7% of transfers result in live births. While that percentage does decrease as the woman’s age increases, it’s still reasonably high for women between the ages of 38 and 40, with 28.5% of transfers resulting in live births.

Lifestyle changes

Sometimes treating unexplained infertility can be as simple as making some important lifestyle changes. Maintaining a healthy body mass index (BMI) can help balance hormones within the body and improve chances of pregnancy. Providing your body with the proper nutrition and exercise, as well as avoiding excess alcohol, can aid in reaching a healthy BMI. Maintaining a tobacco-free lifestyle can also improve chances of conception.

Calculate Your BMI

Although it may seem obvious, both timing intercourse around predicted ovulation and having intercourse frequently can lead to better chances of pregnancy. Young women can use at-home ovulation testing kits for several months to gain a better understanding of their ovulation cycle. It is also recommended they have intercourse every other day during their most fertile time each month.

As studies show egg quality progressively declines around age 35, women in their late 30s and older should forgo spending months trying to time intercourse to overcome infertility and opt for fertility treatment options right away.