Unexplained infertility is a diagnosis given when couples undergo a comprehensive infertility evaluation, and no apparent cause for their inability to conceive is identified. Despite undergoing standard fertility tests and evaluations, the exact reason for the infertility remains unknown.
To reach a diagnosis of unexplained infertility, the following criteria are typically considered:
- Regular menstrual cycles: The woman’s menstrual cycles are regular, indicating that ovulation is occurring.
- Normal semen analysis: The man’s semen analysis shows normal sperm count, motility, and morphology.
- Patent fallopian tubes: Tests such as a hysterosalpingogram (HSG) or laparoscopy have confirmed that the woman’s fallopian tubes are open and not blocked.
- Normal ovarian function: Blood tests and ultrasound examinations indicate normal ovarian function and the presence of mature eggs.
- The uterus must be healthy,i.e, there should be no fibroid or polyp and the mid endometrium thickness should be more than 8 mm.
Despite meeting these criteria, the couple still experiences difficulty in achieving pregnancy. It’s important to note that the diagnosis of unexplained infertility does not mean that there are no underlying issues contributing to infertility. It simply means that the tests conducted thus far have not identified a specific cause.
Several potential factors may contribute to unexplained infertility, including:
- Subtle abnormalities: There may be subtle issues related to egg quality, embryo development, or sperm-egg interaction that are challenging to detect with current diagnostic techniques.
- Hormonal imbalances: Hormonal imbalances that are not easily detectable or within the normal range may affect fertility.
- Undiscovered genetic or chromosomal abnormalities: Some genetic or chromosomal abnormalities may impact fertility but are not detectable through standard testing.
- Environmental and lifestyle factors: Certain environmental or lifestyle factors that are difficult to measure or identify may play a role in unexplained infertility.
IF ALL TESTS ARE NORMAL WHY AM I NOT GETTING PREGNANT?
We must understand that unexplained infertility does not mean there is no cause. Pregnancy is a process consisting of thousands of micro steps. We can only test basic things like the egg, sperm, uterus and surrounding structures, but whether the tube is able to pick the egg, whether the sperm is fertilizing the egg in the tube, whether this fertilized egg which is the embryo is able to swim down the tube and implant into the uterus which again involves thousands of divisions and microcapillary formation which is called implantation- whether all these processes are happening or not cannot be tested. Many times couples ask the doctor when all tests are normal why aren’t we getting pregnant. It basically means that the microprocesses of pregnancy and implantation are not happening and we cannot test those unfortunately, so it is better we move on to advanced form of reproductive treatment and get the pregnancy sooner rather than later.
WHAT IS THE TREATMENT OF UNEXPLAINED INFERTILITY?
The treatment of unexplained infertility depends on the age of the lady, the duration of infertility and the treatment they have had so far for the same. If the lady is young ,duration is less than 2 years and there is not much treatment ,then medication aiding in ovulation induction followed by natural trying and IUI can be tried. These ,if extended for 3 to 6 months can give good pregnancy results. It has been seen that mild super ovulation in women with unexplained fertility increases the chance of success.
For women who are more than 34 years of age, duration of infertility is more than 2 years and who have had rigorous treatment in the form of medications and IUI, the next best option is to go for IVF. It is better that we resort to IVF at this point rather than wait when the lady reaches 38 or 39 when the ovarian reserve and the ovarian capacity becomes low and it is more difficult to get the couple pregnant.