Unexplained Infertility

Unexplained infertility is a diagnosis that no one is happy with at first, not the patient and certainly not your doctor and his team. Yet, it is important to keep in mind that this diagnosis is not the end. It is a beginning. It simply means that your doctor and his team are still trying to figure out your particular challenge or, as is often the case, your combination of challenges.

About ten percent of infertility patients are given this diagnosis after the initial round of tests fail to give doctors a clear answer. Basically, we’re saying: “We’re still working on this one.”

The initial round of tests usually includes:

Sperm including a semen analysis and looking for antisperm antibodies.
Cervical mucus; to make sure the sperm can gain entrance into the uterine cavity.
Uterus and tubes conditions
Ovulation
Adequacy of the luteal phase by measuring progesterone
Quality of the eggs as best we can by FSH and AMH levels.

The next step is for us to look at duration of infertility and the age of the female partner but there is no sure fire therapy until we figure out what is going on in your specific case. The good news is that its not uncommon for couples with one to three years of unexplained infertility to conceive without help.

Still, rather than wait around for Nature to surprise us, we will next check whether the female patient’s eggs travel from the ovary into the fallopian tube, or whether something is interfering with their journey. We can check the pelvis for adhesions and endometriosis, which would keep the tubes from properly “picking up the eggs.”

If the egg is making it into the tube, we’ll look at whether it is being fertilized? We know that even semen that tests normal may not penetrate or fertilize the eggs. Still, there is no certain way to know if this is occurring unless the patient becomes pregnant on her own or in vitro fertilization is done to add the sperm to the eggs in a Petri dish.

If your eggs are entering the tube and being fertilized, the next step is to look at your embryos. We’re like detectives, checking every possible source in a very complex case. For example, certain couples have normal tests but when they do vitro fertilization their eggs fertilize yet divide slowly into poor-quality, fragmented embryos. These can cause infertility, but it is not possible to know that except through vitro fertilization.

For more on unexplained infertility, check the book or consult with your infertility specialist. Don’t give up hope. We’ve seen so many of these cases have happy endings and the science is rapidly progressing every day.