Introduction
You have been trying to get pregnant for over a year with little success and have decided to get evaluated for the potential cause(s). You are hopeful for answers and solutions. However, after a plethora of blood tests, semen analyses and ultrasounds, when the fertility doctor says everything looks normal and there is no explanation for not conceiving, it gives a sense of hopelessness, and your childbearing dream seems distant. This can be due to Unexplained Infertility.
What is Unexplained Infertility?
About 15-30% of couples struggling with infertility end up with a diagnosis of unexplained infertility. These couples have normal sperm parameters, fallopian tubes are unblocked (checked on HSG), uterine lining is fine with no fibroids/polyps (checked on USG and hysteroscopy), periods are regular, ovarian reserve is satisfactory, and no anatomical problems in the male partner, either. But the events leading to childbirth are complex and intricate; disruption at any stage, at the male or female level, can cause infertility.
Many studies disregard the term ‘unexplained infertility’ as just our inability to fully understand and diagnose it. Though science has progressed to identify major problems, there is still so much we don’t know about reproduction or cannot test.
Doctors’ approaches vary as there are no set guidelines for infertility diagnosis, and testing is specific to the couple’s indication. Thus, doctors may not have performed some tests before giving an unexplained infertility diagnosis. The quality of the reports may also not be good enough, or standard testing may not identify the subtle changes related to infertility.
Possible subtle factors influencing fertility:
- Poor egg or sperm quality: Tests are available to check the number of eggs, but no tests for the quality of the ovulated egg. Sometimes poor sperm quality may not be apparent on semen analysis.
- Borderline semen analysis reports: Reports don’t show gross problems, but parameters fall on the lower side of normal.
- Inability of healthy sperm to penetrate the healthy egg
- Poor embryo quality: The formed embryo is unable to divide properly and grow
- Implantation problems: Problems with the uterine lining that prevent the embryo from attaching and growing
- Undiagnosed endometriosis: Only an invasive laparoscopy can confirm endometriosis, which doctors do not routinely perform unless strongly indicated.
- Incompatible cervical mucus: The Cervix is the entry point of the sperm into the uterus. If the mucus is not hospitable for the sperm, they may not survive to reach the uterus and the egg. There is no direct test to identify this.
- Either partner may have some undiagnosed medical condition not directly related to the reproductive system, but that may impact fertility.
- It can be idiopathic infertility, wherein there is an identified problem with the egg or sperm, but the cause of that particular problem is unknown.
Possible Solutions
Having said this, it does not mean you will never be able to have a child. A recent study has shown that about 92% of couples with unexplained infertility, who initiated treatment, have ultimately been able to conceive.
There are certain options and management approaches your fertility specialist may try to help you achieve pregnancy.
Lifestyle changes:
Maintain a healthy diet, weight and exercise routine (don’t overdo it); kick that butt you’ve been meaning to (quit smoking), cut alcohol intake, take supplements, be mindful of the toxins exposure which can hamper fertility.
Timing intercourse:
There is only a small fertility window each month to get pregnant naturally. It is thus essential to time your intercourse for the most fertile days around ovulation. Keep an eye on the changes in the cervical mucus consistency, use at-home ovulation kits or get sonographies to track ovulation.
Assisted reproductive techniques:
Reproductive medicine has progressed a great deal over the years, and assisted reproductive techniques are now easily accessible to increase your chances of having a baby. The American Society of Reproductive Medicine has devised an approach for the treatment of couples with unexplained infertility:
- Ovarian stimulation with intrauterine insemination (IUI): Medications for stimulating egg production and ovulation are given to the woman, and she undergoes IUI around the time of ovulation.
>IUI involves putting the sperm into the uterus, closer to the egg, to help them reach the egg faster and increase the conception rate. For 3-4 cycles this approach is tried. - In-vitro fertilisation (IVF): If multiple IUI cycles don’t yield success, IVF is the next considered option. It is not the first preferred option due to the complexities and expense involved. IVF involves retrieving the egg and sperm, conducting fertilization outside the couple’s bodies. Doctors then transfer a healthy-looking embryo into the womb for growth.
- Intracytoplasmic sperm injection (ICSI): ICSI is a type of IVF process that involves selecting and injecting a single sperm directly into the egg for improved fertilisation.
IVF can be helpful in finding answers to unexplained infertility in some cases, as the egg, sperm and embryo quality is checked under the microscope. Since doctors perform fertilization and embryo transfer in a controlled setting, they can also uncover and resolve issues with embryo formation, development, and implantation.
If the woman is 35 years of age or above, doctors plan both these treatment options faster with a more stringent timeline.
Conclusion
Getting no clear answers can be distressing for the couple and their families. You must not get disheartened and seek help at such times. Femcare Fertility is an ideal place to start for all your fertility needs. We have one of the best infertility clinics in Kolkata and Pune. Our center has top-end facilities. We also have excellent infertility specialists in Pune and Kolkata. They devise personalized treatment plans. They assist with conception for unexplained infertility. We specialize in providing low-cost IVF treatment and IUI treatment. We do this to minimize the emotional and financial burden you might be facing. Our fertility specialists are always on the same team as you!
FAQ (Frequently Asked Questions)
Question: What is unexplained infertility?
Answer: Unexplained Infertility is a condition in which a couple is unable to conceive after trying for one year, even when all their reports are normal.
Question: What are the possible causes of unexplained infertility?
Answer: Poor egg or sperm quality, unnoticeable ovulation issues, problems with fertilization or implantation, or undetected endometriosis can cause Unexplained Infertility.
Question: Can unexplained infertility be treated?
Answer: Yes. Doctors can treat unexplained infertility. The treatment may include lifestyle changes, ovulation induction, intrauterine insemination (IUI), or IVF. IVF with advanced techniques like ICSI can improve success rates in many cases.