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Unexplained Infertility

a blog by Dr. Mark Payson, Dominion Fertility, December 11, 2014

Undergoing a fertility evaluation can feel like a strange scavenger hunt. You answer all sorts of questions about your history, undergo blood tests for multiple hormones, some of which you have never heard of, undergo an exam and ultrasound, have a dye test (hysterosalpingogram) to assess the fallopian tubes, and convince your partner to get a semen analysis.

Finally you meet with your doctor to review all the results and find out… Nothing is wrong?! Then why am I not getting pregnant?

Many times fertility testing reveals a clear cause of infertility and we can tailor therapy to the diagnosis. However, there are a significant number of patients for whom there is not a clear cause and are diagnosed with “unexplained infertility.”

What does that mean? That the doctors are not smart enough to figure out is wrong with me? What should I do? If there is no clear explanation after the testing it can be frustrating not to have an answer.

The good news is that most patients with unexplained fertility can have success with standard fertility therapies. In fact in some cases you will get pregnant spontaneously without any additional therapy! Every year I have couples who come in for the initial consult and by the time we are reviewing treatment options they have gotten pregnant without intervention.

Treatments for unexplained infertility often start with some type of ovulation medication combined with intrauterine inseminations. This is often referred to as “clomid/IUI” or “letrozole/IUI.”

If those treatments do not work in 3-6 cycles it generally makes sense to move on to in vitro fertilization. For women over 37 or couples with many years of unexplained infertility I usually recommend going directly to IVF, as the other procedures are less likely to be successful. IVF, sometimes employing PGS (preimplantation genetic screening) is very effective for unexplained infertility.

In conclusion, if you have been diagnosed with unexplained infertility, do not be discouraged. It is good that all systems are working! There are many good options and choices out there for you.

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