Unexplained infertility
Unexplained infertility is a condition where the basic fertility tests are normal and still a couple is unable to conceive. Estimates suggest that 10% of couples having trouble in conception have unexplained infertility.
What are the basic fertility tests?
The tests which are carried out during your consultation with a fertility specialist include:
- Ultrasound scan to look for the ovarian reserve (number of follicles in your ovary) and ovulation.
- Imaging studies to ensure that the uterus is normal.
- Tubal patency test such as hysterosalpingogram/ sonosalpingogram/ laparoscopy to ensure that the fallopian tubes are patent.
- Hormonal evaluation is normal.
- Semen analysis of the male partner to look for sperm count, motility, morphology and vitality.
What are the causes of unexplained infertility?
Unexplained infertility may be due to causes in the male or female partner which are not tested. These include:
- Poor quality of egg/ sperm.
- Minimal or Mild grade endometriosis which cannot be picked up on scan or other routinely done tests. Laparoscopy will help in the diagnosis of this condition.
- Inadequate endometrial lining or altered endometrial receptivity which alters the interaction between ovum and sperm.
- Cervical mucus abnormality.
- Inadequately defined immunological causes.
What are the chances of conceiving with unexplained infertility?
Studies have shown that about 92% of couples with unexplained infertility eventually conceived naturally or with treatment. The good news is that everything is normal in the couple evaluation. The bad news is that there is no cause of infertility identified in the evaluation. However, the prognosis is not too bad with timely intervention.
What are the treatment options available?
Assisted reproductive techniques help in conception. These include:
- Ovulation induction with oral medications such as Clomiphene citrate or letrozole with or without gonadotropins.
- Intrauterine insemination will overcome the cervical barrier and lead to pregnancy.
- IVF/ICSI may be useful as the quality of egg, sperm and embryo can be assessed prior to embryo transfer leading to successful pregnancy outcomes.
The choice of treatment depends on various factors such as age of the couple, duration of married life, preference of the couple and previous treatment taken.
Healthy lifestyle goes a long way in favor of conception both naturally and by Assisted Reproductive Techniques.
When should I/we consult Fertility specialist?
Its time to consult a fertility specialist :
- If female is <35 years and has had regular unprotective intercourse for 1 year with failure to conceive.
- If female is >35 years or has irregular cycles and has had regular unprotective intercourse for 6 months with failure to conceive.
Which doctor is best for unexplained infertility treatment?
Dr Sneha J is a Gynecologist and best fertility specialist. She has completed MD OBG from the top university AIIMS , Delhi and University fellowship in Fertility/ Reproductive medicine. She had further training in dealing with these conditions, as a visiting fellow at high output centres in Madrid, Spain and Chicago,USA. A Gynaecologist with training in Reproductive Medicine is best for unexplained infertility treatment.
Frequently Asked Questions
Yes. Unexplained infertility may be considered when standard evaluations of ovulation, ovarian reserve, uterus, fallopian tubes, hormones, and semen do not identify a clear reason for difficulty conceiving. Unexplained infertility does not mean that pregnancy is impossible; it means that the underlying cause has not been identified through routine testing.
Yes. Standard fertility investigations may not detect every aspect of egg or sperm function. Subtle problems with egg and sperm quality can sometimes contribute to difficulty conceiving even when basic test results appear normal.
Yes. Minimal or mild endometriosis may not always be visible on an ultrasound or other routine investigations. In selected cases, endometriosis diagnosis may require further evaluation, including laparoscopy, depending on the patient's symptoms and clinical assessment.
Yes. The thickness and receptivity of the endometrium can influence the interaction between the embryo and the uterine lining. In appropriate cases, evaluation of endometrial receptivity may be considered when unexplained difficulty conceiving persists.
Treatment is not necessarily the same for every couple. Factors such as the woman's age, duration of infertility, previous treatment, reproductive history, and the couple's preferences can influence whether unexplained infertility treatment involves ovulation induction, IUI, IVF/ICSI, or another approach.
IUI may be considered for selected couples because it places prepared sperm directly into the uterus and can help overcome certain barriers to conception. Whether IUI for unexplained infertility is appropriate depends on factors such as age, ovarian reserve, sperm parameters, and previous treatment.
IVF or ICSI may be considered when simpler treatment has not been successful, when age or other fertility factors make more advanced treatment appropriate, or when the couple and specialist decide that it offers a better chance of conception. IVF for unexplained infertility can also allow assessment of egg, sperm, embryo development, and embryo transfer.
The outlook can be encouraging because unexplained infertility means that the basic evaluation has not identified a major abnormality. The page notes that studies have reported about 92% of couples eventually conceiving naturally or with treatment, although the individual likelihood varies according to factors such as age and treatment history. Unexplained infertility success rates should therefore be discussed in the context of each couple's circumstances.
Women younger than 35 are generally advised to seek evaluation after 12 months of regular unprotected intercourse without conception. For women older than 35, or those with irregular cycles, consultation is recommended after about six months. Fertility specialist consultation may also be appropriate earlier when there are known reproductive concerns.
A healthy lifestyle can support reproductive health and may be beneficial whether conception occurs naturally or through assisted reproduction. Maintaining healthy habits alongside appropriate fertility care can form part of an overall approach to improving the chances of pregnancy.
