A couple diagnosed with unexplained infertility simply means that after a thorough evaluation there is no identifiable cause preventing a pregnancy from occurring. Unexplained fertility simply means that your physician cannot find any medical explanation for why you are not able to conceive. This can be extremely frustrating for a couple to hear. Unfortunately, it is quite common and can sometimes be more of a concern than a straight forward diagnosis like male factor.

One explanation can be that these couples are simply unlucky, and don’t have any biological problems interfering with pregnancy. However more often than not there are those couples who do have a medical reason for infertility, but this reason cannot be found due to insufficient medical knowledge or technology. Regardless of the underlying cause, a diagnosis of unexplained fertility is sure to be difficult.

Keep in mind that you are not alone, unexplained infertility is actually quite common. Up to 10% of couples who are seen for infertility evaluation are diagnosed with unexplained fertility. These rates do vary depending on the clinic and geographic location. This condition requires a thorough and expedited evaluation followed by a step by step treatment plan.

The Infertility Evaluation

Unexplained infertility is a diagnosis of exclusion, meaning all other known causes have been ruled out. Your physician will perform a complete history and physical examine on you and perform a battery of tests to try to determine exactly what is going on. These tests may include the following:

• Confirmation of normal ovulation with hormonal testing
• Confirmation that you fallopian tubes are open by HSG or laparoscopy
• Confirmation of a normal uterine cavity by HSG or saline sonogram
• Confirmation of normal sperm parameters by having your partner undergo a semen analysis
• Rule out pelvic adhesions or endometriosis with laparoscopy
• Rule out diminished ovarian reserve with a day 3 FSH or AMH level

There may be other tests recommended in the past however they have not been shown to be useful in directing appropriate treatment or increasing the chance of a live birth.

There are a number of things that may play a role in your unexplained infertility and can be very subtle. The fallopian tubes may be patent or open but not functioning normally. The fallopian tubes assist in picking up and transporting your eggs. The fimbria are finger-like projections located at the ends of each fallopian tube which actively pick up the oocyte and the cilia, which are like tiny hairs, that help to transport the egg to the site of fertilization. The cilia also transport the fertilized egg, now an embryo, back into your uterus. Subtle problems with the fimbria or cilia can prevent a pregnancy from occurring.

Ovaries contain thousands upon thousands of eggs, however not all of these eggs are suitable for fertilization and division. Eggs need to contain the right chromosomes to result in a live birth. Ovarian reserve is an indirect measure of your egg quality and is tested by having a day 3 FSH drawn or an AMH level. Though these tests are not %100 in predicting a failure of a live birth when elevated have live birth rates of < 1%. Patients can have a normal FSH and AMH and still have subtle issues with egg quality.

Subtle hormonal abnormalities such as thyroid issues, high prolactin levels or inadequate luteal phase can contribute to infertility. The good news is that they typically can be diagnosed and corrected with the proper medication or progesterone supplementation. These levels should be checked often so that we do not miss an abnormality over a long period of fertility treatments.

There can be subtle sperm issues as well. The semen analysis can be read out as completely normal yet the sperm still have trouble fertilizing the egg inside the female’s fallopian tube. Again this can be easily corrected with IVF and ICSI.

Minor abnormalities with the uterine cavity can also be a cause of a failed pregnancy. There can be polyps, fibroids or scar tissue that all can impact the embryo implanting in to the uterine lining. Most of the time they are diagnosed early in the evaluation and the majority of these issues can be fixed with out patient surgery. Another more rare condition is endometrial insufficiency which is when the uterine lining does not grow as thick as it should. There are various treatments used to help this condition but when they fail a gestational carrier is required.

In addition to the conditions listed above there may be other factors that we are not currently able to reliably diagnose such as immune issues or implantation issues. As science advances we may discover many more reasons for a couples inability to have a child.

Infertility Treatment Options

If you receive a diagnosis of unexplained infertility, there is no reason to give up hope. There is still a chance that you will get pregnant on your own, without any treatment. The “normal” fertile couple has about a 20% chance of conceiving each month while those couples with unexplained infertility may have a < %5 chance. We use various fertility treatments to help increase your chances of getting pregnant each month, hopefully getting closer to that 20% mark. These treatments do come with risks, mostly in the form of multiple pregnancies such as twins, triplets or worse.

Clomid and injectible fertility medications (gonadotropins) can allow more eggs to ovulate each month and HCG injection can ensure the timing of ovulation, thus increasing your chances of fertilization.

Intrauterine insemination or IUI can increase the number of motile sperm at the site of fertilization. Sperm from your partner is processed or washed and then placed in a small catheter. This should increase the chances of natural fertilization occurring.

In vitro fertilization or IVF is most certainly the best treatment option for unexplained infertility though it is the most expensive and most involved. Since time is critical in this entire process those unsuccessful with the more conservative treatments listed above should move quickly to IVF. Problems with the sperm and/or tubes can be easily corrected this way. IVF is performed by removing the eggs from your ovaries and fertilizing them in a dish containing your partner’s sperm. Once the eggs have developed into embryos, they are then implanted into your uterus. Even subtle egg issues can be helped by IVF. Unexplained infertility can successfully be treated with a thorough and speedy evaluation followed by a well thought out treatment plan.

If you would like to schedule a consultation with RMA of Michigan please contact us at 248-619-3100.