Unexplained Infertility

Although up to 15% of infertile couples are diagnosed with “unexplained infertility”, infertility is generally diagnosed when conception does not occur after one year of unprotected intercourse in couples where the woman is under age 35. Where the woman is 35 or older, the diagnosis of infertility is usually made once a couple has been trying to become pregnant for only six months. This decision is based on the fact that a woman’s reproductive potential declines after the age of 35.

“Unexplained” means that, at the time of diagnosis, a conventional battery of fertility tests for both partners has failed to reveal a cause for infertility.

Determining Tests

Individual healthcare providers differ as to what they consider to be a conventional panel of infertility tests. Generally, though, in addition to reviewing medical history and completing a physical examination, they include the following:

For women:

Blood hormone level tests
Ovulatory function tests
Post-coital tests
Transvaginal ultrasound
Hysterosalpingogram (HSG) (x-ray of uterus and fallopian tubes using radio-opaque dye)
Laparoscopy (tiny telescope inserted into abdomen to examine uterus, ovaries, fallopian tubes)

For Men:

Hormonal tests
Semen analysis
Additional tests for sperm motility, sperm penetration, antibodies, blockage or infections

How Is It Treated?

Just as the tests used to diagnose unexplained infertility vary according to the healthcare provider, so too do the treatments offered for that condition. However, often the following treatments are used:

Ovulation induction drugs, such as clomiphene citrate; sometimes human menopausal gonadotropins (hMG) or follicle-stimulating hormone (FSH) drugs
Intrauterine insemination (IUI) (artificial insemination of sperm into the uterus)
In vitro fertilization (IVF) (eggs and sperm are combined in a laboratory, then any fertilized eggs are inserted into the uterus)

A diagnosis of unexplained infertility can be difficult and frustrating, especially since couples usually enter into testing with an expectation that a cause will be identified. Many couples have an overwhelming urge to keep searching for answers, and they may not know when to stop. Counseling can provide much needed support couples in this situation.