unexplained infertility
Although up to 10 % of infertile couples are diagnosed with idiopathic or “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 distinction is based on data suggesting that a woman’s reproductive potential declines after the age of 35.
“Unexplained” means that a conventional battery of fertility tests for both partners has failed to reveal a cause of infertility.
determining tests
Individual healthcare providers differ as to what constitutes a conventional panel of infertility tests. After reviewing the medical history and completing a physical examination, they may include the following:
For women:
- Blood hormone levels
- 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:
- Hormone tests
- Semen analysis
- Additional tests for sperm motility, sperm penetration capacity, 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. The following treatments may be recommended:
- Ovulation induction drugs, such as clomiphene citrate; sometimes human menopausal gonadotropins (hMG) or follicle-stimulating hormone (FSH) drugs (Follistim® AQ Cartridge)
- Intrauterine insemination (IUI) (artificial insemination of sperm into the uterus)
- In vitro fertilization (IVF) (eggs and sperm are combined in a laboratory, then fertilized eggs/embryos are transferred into the uterus)
The emotional reaction to a diagnosis of unexplained infertility can be difficult and frustrating, since couples start testing with the expectation that the test results will reveal a cause for their infertility problem. It is not uncommon for couples to relentlessly pursue their search for answers and some couples have great difficulty deciding when to discontinue treatment.