Around 10 to 15 percent of infertile couples will receive a diagnosis of unexplained infertility. This can be incredibly frustrating, even though in vitro fertilization (IVF) is typically a good treatment for the diagnosis.
"There's probalby more unexplained infertility because we're doing fewer diagnostic tests than we used to," says Brad Hurst, M.D., Director of Assisted Reproduction with the Center for Reproductive Medicine at Carolinas Medical Center's Women's Institute. He explains that during the 1990s, physicians would perform routine laparoscopy — a surgery that uses a thin, lighted tube put through an incision in the belly to look at the female pelvic organs — to diagnose infertility, and they often found endometriosis or adhesions.
"Laparoscopy wasn't a very cost effective approach," Dr. Hurst says, "and when we do laparoxopy and find and treat endometriosis, we find that we only improve the monthly pregnancy rates by 1 percent or 2 percent. So, the current standard is to do semen analysis, ovarian reserve testing, some type of means to confirm ovulation, and a hysterosalpingogram to assess the uterus and tubal patency, and if those things are normal, the couple is assumed to have unexplained infertility."
Now, however, a procedure that has been approved for use in the United States during the last year is available to better find the source of a woman's infertility: Fertiloscopy.
Last month, Elle carried a story about Atilla Toth, a fertility doctor in New York who is using a controversial regimen of antibiotics to treat infertility. I’m not talking about a couple of horse pills taken for 10 days; I’m talking about months of IV antibiotics, antibiotics shot through a catheter into the cervix, and another antibiotic paste inserted into the uterus. And that’s just for the female half of the equation. The males? Well, the men suffer too. “Meanwhile,” writes Elle’s Sarah Elizabeth Richards of one woman she profiled, “every other day Toth gave her husband a painkiller and then injected antibiotics through his rectum and into his prostate; twice Toth also injected his seminal vesicles.” Yeeeeeeeowch!
When you are under 35 and have been trying to conceive for one year or over 35 and trying to conceive for six months, and your infertility workup shows normal results, your diagnosis may be "unexplained infertility." About one in five couples are diagnosed with unexplained infertility.
Diagnostic testing is done to identify the major causes of infertility based on their medical history. In about 10% of all cases, a couple (age less than 35 years old) will get a very unsatisfying result: Unexplained infertility. The diagnostic testing we have available will only identify the major reasons why a couple may have a difficult time getting pregnant but it certainly can not identify all of the reasons. If the fallopian tubes are blocked or there is no sperm, these are obvious major obstacles to becoming pregnant. There are no tests available for more subtle infertility factors such as inadequate egg quality or fertilization failure.
Historically, patients with unexplained infertility would take a step-wise treatment algorithm, starting first with the simplest treatment (oral medications) and after a trial period move up to injectable hormones and insemination, finally stepping up to IVF treatment if unsuccessful. Modern treatment, however, has altered this approach.
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!
a blog by Dr. Mark Payson, Dominion Fertility, December 11, 2014
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.”