The diagnosis of unexplained fertility is extremely frustrating, and it is quite common. Around one in five infertile couples are told that the doctors are unable to identify any specific reason for their conception problems.

So, when you don’t know what’s wrong, how can you find a solution to it? Not all hope is lost because even if your infertility cannot be explained, it can be treated.

Is your infertility really unexplained?

Typically, when you’ve been trying to conceive for a few months and not had any success, you will approach a fertility specialist, who will order some tests and investigations.

If your medical history and those investigations do not tell anything, it will be labeled a case of unexplained infertility.

At the same time, if you approach another, differently experienced doctor, they may be able to identify sometime they’ve seen before or just suggest that you haven’t been tested adequately and order some more investigations that could actually point to the real reason for your fertility problem.

Complete fertility evaluation for women and extensive semen analysis for men, including sperm DNA testing is imperative before jumping on to treatments.

If, despite all these tests, your doctor is unable to give you any possible cause for your infertility, it is time to start planning the treatment,

The best approach in unexplained infertility is to treat it empirically—relying on the experience and observation of a trusted doctor.

Age factor in infertility

Once you’ve gone through all the investigations and your infertility still remains “unexplained,” the doctor may provide several options, depending upon your age.

Women in their late 30s and 40s, may be advised to go straight to IVF as the doctors don’t want to waste precious time and go on to the treatment with highest chances of success.

Even though average global success rate for IVF is only around 50%, it is significantly higher than other treatments like artificial insemination that only bring around the desired results in 10%-15% of patients.

In younger women, after considering their hormones and ovarian reserve, the doctor may advise them to try naturally for some time or consider milder treatments, before starting the more expensive IVF cycle.

Possible reasons for unexplained infertility

Unexplained infertility doesn’t mean there isn’t an underlying factor, it only means, we don’t know what it is. It could be any of the below:

  • Weighing too much or too little – Having a BMI too high or too low may cause infertility and if you’re obese losing weight may help you conceive. This is applicable to both men and women.
  • Thyroid problems – Hypothyroidism is known to cause irregular menstrual cycles, ovulation problems and infertility. Higher TSH levels are associated with unexplained infertility, and checking thyroid function has become a part of fertility testing.
  • Diabetes – Spermatogenesis is altered in men with insulin deficiency or insulin resistance and it may potentially cause male infertility. In women, diabetes is associated with ovulatory dysfunction and PCOS, which may be the cause of your infertility.
  • Mild endometriosis – Numbers indicate that endometriosis is present in 20% – 40% women that are diagnosed with subfertility. While advanced endometriosis can be diagnosed and resolved, mild endometriosis that does not cause adhesions or tubal defects is associated with infertility in some women. Irrespective of the severity of the disease, all women with endometriosis have certain amount of toxic peritoneal factors that can interfere with egg fertilization.
  • Hostile cervical mucus that carries anti-sperm antibodies – Reproductive failure is sometimes caused by sperm-reactive anti-bodies in the female’s cervical mucus. An understanding and identification of these antibodies will be very useful in eliminating a possible reason for unexplained infertility.
  • Poor egg or sperm quality – Gamete quality is an important factor for successful conception, and while the sperm quality is almost accurately tested with semen analysis, there is no way to determine the quality of eggs before they have been released from the ovaries. There are certain ways to improve your egg quality, which may be helpful in over-turning unexplained infertility.
  • Problem with the genetic content of your gamete(s) – Normal semen analysis does not offer an insight into the sperm DNA quality, which is responsible for many cases of unexplained infertility and miscarriages. 
  • Undiagnosed Celiac diseaseResearch has indicated that gluten sensitivity and undiagnosed celiac disease may cause problems with female reproduction.

Any systemic disease that makes carrying a pregnancy unfavorable for your body, could also be a hindrance to conceiving and may be the reason behind your unexplained infertility.

It is possible that some people may evaluate themselves for the all the above factors and still not be able to find a reason for their infertility. However, for most, an evaluation with respect to the above list will be useful in eliminating various possible reasons for unexplained infertility and taking a step closer to conception.

Lifestyle changes

If you suspect any of the above reasons could possibly be causing your infertility, it will not be hard to adjust your lifestyle accordingly. You could lose weight or bring your thyroid or diabetes under control to have better chances at conceiving, with or without medical intervention.

Besides, there are some things that help improve your fertility, which can be put into practice even if you have no idea about the reason behind your infertility.

Remember, there is some imbalance in the body that is causing the problem and general health practices may prove helpful.

IUI or IVF for unexplained infertility?

Various randomised trials have shown that the chances of conceiving naturally or by doing IUI without medication, are only around 4 percent in patients of unexplained infertility.

IUI following stimulation with Clomid or Clomiphene Citrate seems to double the chances of success, taking it to almost 8 percent.

Gonadotropin injections before IUI further raise these chances to 17 percent, and the highest success rates are obviously seen with IVF or ICSI procedures.

However, average success rates in IVF can be misleading as they are not indicative of the full picture. Different patients have different factors that contribute to the success or failure of their IVF and the same treatment may be differently received by people with different conditions.

So, the success, especially in cases of unexplained fertility, cannot be predicted accurately. Doctors with more experience might have seen more cases like yours, so they may be able to direct you better towards the treatment likely to be more effective in your individual situation.

IVF failure in unexplained infertility

There are several reasons for IVF failure, but when the cause remains undiagnosed, it is natural for the patients to be frustrated and unsure of which step to take next.

This is when the doctor’s experience and an empirical approach to treatment becomes important. If you fail an IVF cycle and the cause of infertility is unknown, an experienced doctor may be able to guide you better. Sometimes, a failed cycle of IVF takes the doctor closer to reaching a diagnosis or forming a better understanding of your situation, even in cases of unexplained infertility.

The infertility is not always “unexplained,” it may just be “undiagnosed.”

While infertility and conception problems are difficult for most people, the most frustrated are those who are told it is unexplained infertility.

The diagnosis and treatment of unexplained infertility can be more complicated that other cases, and you must seek an experienced doctor for help through it. To consult with any of our fertility specialists, get in touch.

Resources:

Bronson R; Cooper G; and Rosendfield D. (1984) Sperm Antibodies: their role in infertility. Fertil Stertil, 42, 171-183. https://www.fertstert.org/article/S0015-0282(16)48009-X/pdf

Hart R. (2003). Unexplained infertility, endometriosis, and fibroids. BMJ (Clinical research ed.), 327(7417), 721–724. https://doi.org/10.1136/bmj.327.7417.721

L Grode, B H Bech, O Plana-Ripoll, M Bliddal, I E Agerholm, P Humaidan, C H Ramlau-Hansen, Reproductive life in women with celiac disease; a nationwide, population-based matched cohort study, Human Reproduction, Volume 33, Issue 8, August 2018, Pages 1538–1547, https://doi.org/10.1093/humrep/dey214

Condorelli, R. A., La Vignera, S., Mongioì, L. M., Alamo, A., & Calogero, A. E. (2018). Diabetes Mellitus and Infertility: Different Pathophysiological Effects in Type 1 and Type 2 on Sperm Function. Frontiers in endocrinology, 9, 268. https://doi.org/10.3389/fendo.2018.00268

Orouji Jokar, T., Fourman, L. T., Lee, H., Mentzinger, K., & Fazeli, P. K. (2018). Higher TSH Levels Within the Normal Range Are Associated With Unexplained Infertility. The Journal of clinical endocrinology and metabolism, 103(2), 632–639. https://doi.org/10.1210/jc.2017-02120