Unexplained Fertility Facts

It’s already challenging enough for couples who struggle with conceiving; receiving an unexplained infertility diagnosis only worsens the situation. Approximately 25% of couples experiencing fertility challenges will receive this diagnosis. The reality is that this is both good and bad news. Good news because unexplained infertility means doctors haven’t found anything specific that prevents you from getting pregnant.

So, there’s a reason to be hopeful. In fact, depending on your age and for how long you’ve been trying to conceive, the chances of getting pregnant are higher compared to most infertility diagnoses. The bad news is that there’s no exact explanation for why you’re unable to conceive. Read on to learn more about unexplained infertility and what to do.

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What Counts As Unexplained Infertility?

When a healthcare professional performs common infertility testing and doesn’t find any reason for a couple’s inability to conceive, then he declares it as unexplained infertility. So, it’s a diagnosis of elimination or a non-diagnosis. Your reproductive specialist has determined that you don’t have a specific set of problems, yet you’re unable to get pregnant. But while one professional may determine your case as unexplained, another specialist may say that you haven’t taken all the necessary tests, and he may be right. Both the female and male partners will have to undergo a full and complete fertility assessment to determine a case of unexplained infertility.


According to Linda Loma Fertility, It is estimated that approximately 15% to 30% of couples with infertility problems are diagnosed to have unexplained infertility, making it one of the biggest causes of infertility. The reason for the big gap in estimated percentages is that the experts haven’t settled on what comprises “standard infertility testing.”

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How To Test For Unexplained Infertility

Infertility assessment can differ based on the couple’s situation and their doctor’s testing protocols. However, the American Society for Reproductive Medicine provides guidelines for standard infertility, including:

  • An ovulation assessment to check whether you’re ovulating regularly.
  • A Hysterosalpingogram (HSG) to check the condition of the fallopian tubes (whether they’re open and healthy).
  • A doctor uses a hysteroscopy to check the uterus for any severe uterine fertility problems.
  • An ovarian reserve evaluation done via antral follicle count or blood work.
  • A semen analysis to determine your partner’s sperm count, shape, and motility.

According to Very Well Family, If all of the above haven’t been assessed, it is premature to diagnose a couple with unexplained fertility. So, a fertility specialist may recommend a diagnostic laparoscopy to rule out endometriosis. It’s a minimally invasive surgical method where the doctor inserts a tiny camera inside your uterus, letting him see your internal organs and conditions. An ultrasound or blood work cannot diagnose endometriosis.

And not unless you have painful periods; your doctor may find it unnecessary to perform a surgical laparoscopy. Your fertility specialist will perform all of these tests and a physical exam, and check your medical and sexual history, to check for any issues affecting fertility.

After performing these tests, the doctor may diagnose both of you with unexplained fertility issues. The diagnosis can be stressful because you’re aware that you have a problem but not what’s causing it. As with some conditions that cause infertility, unexplained fertility can, over time, correct itself. In fact, research performed on over 1,300 women with infertility in 2012, aged from 28 to 36, revealed that 43% of the women who never got fertility treatments eventually got pregnant and delivered.


What May Cause Unexplained Infertility

There’s an explanation for unexplained infertility. It’s just not known yet. Here are some probable explanations for this condition:

  • The quality and quantity of the eggs – According to Advanced Fertility, the chances of getting diagnosed with unexplained fertility substantially in women over 35 years and increase further in women over 38. The older women are, the more likely they have egg quantity and quality issues. And since there’s no “standard category” named egg factor infertility, these couples are automatically thrown into the “unexplained” infertility category. Women over 40 will experience difficulty trying to conceive, and it gets worse for those over 45 because the chances of conceiving after 45 are rare – even though they have regular monthly menses. So, the older the woman, the more likely she’s experiencing an egg-related problem causing the fertility issue, and there’s no specific test to check egg quality.
  • An undiagnosed underlying condition that is non-reproductive may affect fertility. For example, some cases of untreated Celiac disease, some autoimmune diseases, diabetes, and thyroid disorder may affect fertility.
  • Mild endometriosis– Severe endometriosis will likely cause noticeable fertility problems, even without a laparoscopy. For example, fallopian tube blockages or endometrial cysts may affect ovulation. On the other hand, mild endometriosis may not affect ovulation or prevent egg passage, and the signs may be missed. However, endometriosis may be to blame for some unexplained infertility cases.
  • Poor sperm quality– Diagnosable sperm problems, including poor sperm shape and motility, may cause infertility. However, some sperm-quality issues may not be obvious in semen analysis and can only be diagnosed during IVF treatment. For instance, sperm may have bad quality DNA, which increases with age. This explains why kids born to older men are at a higher risk for some birth disorders and mental health issues.
  • Endometrial problems– A healthy embryo may be unable to impact the endometrium, and this is problematic.
  • Unknown factors – Not all is known about fertility yet, and unknown factors could cause your unexplained infertility.
  • Nothing’s wrong – Some causes of unexplained infertility will resolve within 12 to 24 months after diagnosis, and no one can explain what was wrong. The odds are never 100% for anyone. Even a healthy, fertile couple only has about 30% odds of getting pregnant in any given month.
  • Maybe, it’s just a case of subfertilitya small fertility problem that needs time to resolve on its own.


Treating Unexplained Infertility

Since there’s no definitive cause, the treatment recommended for couples with unexplained infertility normally focuses on the most likely causes. Here are common treatments:

  • Intrauterine insemination (IUI) – It’s a kind of artificial insemination involving sperm washing and concentration and then putting it into the woman’s uterus directly, around when they’re ovulating.
  • Planned sexual intercourse- You’ll be guided on timing sex regularly to coincide with ovulation.
  • Clomid– Clomid pills can trigger increased egg production per month instead of only one. It is normally used together with IUI.
  • Injectable gonadotropins– These medications have hormones that stimulate egg release and can treat low sperm count, and they’re used together with IUI treatment, increasing the success rates with unexplained infertility.
  • Changes in lifestyle changes – You may be advised to quit smoking, reduce alcohol and caffeine intake, and maintain a healthy weight, all of which can boost fertility.
  • IVF treatment– IVF is the priciest yet most effective solution for unexplained infertility. Doctors will normally perform IVF in a process known as Intracytoplasmic Sperm Injection (ICSI) for unexplained infertility.


Sources: Advanced Fertility, Linda Loma Fertility, Very Well Family


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