I Have Unexplained Infertility. What Can I Do?

So you’re under 35 years old and you’ve been trying to conceive for a year, or you’re over 35 and you’ve been trying for six months.  You’ve been to a fertility center and consulted a fertility specialist.  You and your male partner have had the recommended testing.  The fertility doctor said to you, “Your test results are in the normal range.  You have what is called unexplained infertility.” This can feel disheartening when you have been trying to get pregnant with no success, and can be emotionally distressing for both the couple and the physician.  The doctor wants to help patients build their families, and patients may go from doctor to doctor seeking a solution.  Let’s explore the steps that can be taken if diagnosed with unexplained infertility..

Tests for Unexplained Infertility?

Unexplained infertility is a diagnosis of elimination—if no medical cause for infertility is revealed by the testing of both partners, then the inability to get pregnant is unexplained.  In as many as 5 to 10 percent of couples trying to conceive the test results are normal and there is no apparent cause of infertility, according to the American Society for Reproductive Medicine (ASRM.)  These tests are standard procedure for reproductive endocrinologists and include semen analysis for the male partner and blood tests for follicle stimulating hormone (FSH) and other hormones, a hysterosalpingogram (HSG) and a transvaginal ultrasound for the female partner. There are other tests that can be performed to pinpoint the problem, but they will not affect successful fertility treatment.  Some doctors perform laparoscopy, which procedure is carried out under general anesthesia and allows the doctor to look for signs of endometriosis and remove scar tissue that may block the fallopian tubes.  However, many experts feel that if the tubes are blocked, IVF is the most successful fertility treatment.  And if the tubes are not blocked and you can’t get pregnant, IVF is still the most successful treatment. Two other tests that may be suggested to you are endometrial biopsy, to check for problems with the menstrual cycle between ovulation and menstruation, and postcoital tests, taken immediately after intercourse to evaluate sperm, cervical mucus, and the interaction between the two.  ASRM does not recommend these tests.  Here’s a quote from their online patient guide, “Infertility:  An Overview”: “Endometrial biopsy to look for luteal phase defect is not routinely done by most infertility specialists because the information has not usually been helpful in improving pregnancy rates,” it says of the first. And of postcoital tests: “Many physicians are not currently recommending this test because it has not been shown to be of value in increasing pregnancy rates.” Some doctors are doing research on various chromosomal and DNA tests which may have potential in the future.  If you are asked to participate in such a test, ask your doctor who will pay for it, how it will affect your treatment and what the evidence is for this test.

So, What Can You Do to Conceive?

If you are under 30 or 35 years old, time is on your side.  You may just be at the slow end of the fertility curve and will get pregnant if you give it more time.  If you are 35 or older, or simply don’t want to wait longer to conceive naturally, it may be the right time to start fertility treatments.  Some fertility specialists may recommend IUI, intrauterine insemination, and fertility drugs for a few cycles, while others may recommend that you have in vitro fertilization. IVF allows you and your doctor to limit the possibility of multiple births and increase your chances of getting pregnant. Consult your Reproductive Endocrinologist on the best treatment plan for you and your partner.