“Hold on, what do you mean you don’t know? Even after all of those tests, you still don’t have any answers as to why we can’t get pregnant?”
This has probably crossed your mind after being told you have unexplained infertility. Approximately 15% to 30% of couples will be diagnosed with unexplained infertility even after going through a complete fertility work-up.
There’s an intense emotional response to hearing, “There is no apparent reason for your infertility”. It can be difficult, maddening and equally frustrating for both you and your partner. People who do find out a specific cause find their situations difficult, too, of course, but knowing the “whys” makes it more bearable. In cases of unexplained infertility, couples feel that one reason, one cause is lurking in a shadowy corner. It just hasn’t been uncovered yet.
Infertility is customarily defined as the inability to conceive after 1 year of regular unprotected intercourse. The infertility evaluation is typically initiated after 1 year of trying to conceive, but in couples with advanced female age (> 35 years), most practitioners initiate diagnostic evaluation after an inability to conceive for 6 months.
Unexplained infertility does not, however, mean that you have no options. There is a reason for hope.
In fact, depending on your age and how long you’ve been trying, the odds of conceiving on your own may be higher than it is for most infertility diagnoses. One study of just over 1,300 women with infertility, ages 28 to 36, found that 43 percent of those who never received fertility treatment eventually conceived and gave birth.
Unexplained infertility is a controversial diagnosis. By definition, it’s a diagnosis of elimination. Your doctor has determined you do not have this, this, and this problem, and yet, you’re not able to conceive.
However, while one doctor may diagnosis your case as unexplained, another fertility specialist may say you just haven’t been fully evaluated. And that doctor may be right. Unexplained infertility can only truly be diagnosed after a full and complete fertility evaluation of both the male and female partner.
The Practice Committee of the American Society for Reproductive Medicine (ASRM) has published guidelines for a standard infertility evaluation. It includes a semen analysis, assessment of ovulation, a hysterosalpingogram, and, if indicated, tests for ovarian reserve and laparoscopy. When the results of a standard infertility evaluation are normal, practitioners assign a diagnosis of unexplained infertility. Although estimates vary, the likelihood that all such test results for an infertile couple are normal (ie, that the couple has unexplained infertility) is approximately 15% to 30%. (NCBI)
An unexplained infertility diagnosis may be justified if it has been shown that…
- You are ovulating regularly.
- Your ovarian reserves are good. (Evaluated with blood work and/or an antral follicle count.)
- Your fallopian tubes are open and healthy. (Evaluated with an HSG.)
- Your partner’s semen analysis is normal (including total count, sperm movement, and sperm shape.)
- There are no serious uterine fertility issues. (Evaluated with a hysteroscopy.)
If any of the above has not been evaluated, a diagnosis of unexplained infertility may be premature.
Some may also argue a laparoscopy is also needed to rule out endometriosis. Endometriosis cannot be diagnosed with blood work or ultrasound.
The principal treatments for unexplained infertility include expectant observation with timed intercourse and lifestyle changes, clomid and intrauterine insemination (IUI), controlled ovarian hyperstimulation (COH) with IUI, and IVF.
Studies indicate cigarette smoking, abnormal body mass index (BMI), and excessive caffeine and alcohol consumption reduce fertility in the female partner. The female partner should be counseled to achieve a normal BMI, reduce caffeine intake to no more than 250 mg daily (2 cups of coffee), and reduce alcohol intake to no more than 4 standardized drinks per week.
Have you received a diagnosis of unexplained fertility? Were you able to get pregnant? We’d love to hear from you!! Feel free to comment below or send us an email at thouston8919@yahoo.com
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