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In a world where patients (and doctors) expect clear explanations for a problem, the diagnosis of “unexplained” infertility can be hard for patients to take in. Patients are often frustrated with this diagnosis and assume that because there is no clear explanation of why they are not pregnant, there must not be a solution. Not so!
Understanding “unexplained” infertility
Couples with unexplained infertility are not getting pregnant despite a normal basic evaluation. Put simply, couples with unexplained infertility produce eggs (normal ovarian function), produce sperm (normal semen analysis), and have normal fallopian tubes where eggs and sperm can fertilize before implanting in the uterus (normal hysterosalpingogram).
While we don’t truly know why (thus the term “unexplained”), patients likely have subtle difficulties with fertilization, development of the embryo before it attaches to the uterus, transport of the embryo from the tube to the uterus, and implantation of the embryo in the uterus. Many strategies are being developed (genetic testing of eggs of and sperm, IVF with genetic diagnosis of embryos, endometrial function testing – just to list a few) to diagnose such subtle problems, yet none have been firmly established and are used routinely in clinical practice.
What does unexplained infertility mean for me?
Patients with the diagnosis of “unexplained” infertility are among our most successful and the vast majority get pregnant. Depending on the patient or couple’s age(s), past history, and prior treatments, a variety of treatment strategies can be used. Typically, I start with “superovulation” – giving a woman medicine (pills or injections) to make her produce more than 1 egg in a given month – followed by “insemination.” By increasing the number of eggs produced and placing sperm near the egg at the perfect time, the majority of couples are successful. If not pregnant initially, I will adjust the medication dose depending on how the individual patient responded to therapy. If we are not successful after multiple attempts, I typically recommend in-vitro fertilization (many more blogs to come on this BIG topic!)