When a fertility specialist cannot identify a specific cause of infertility after comprehensive testing and evaluation of a couple or individual, he or she gives a diagnosis of unexplained infertility. According to ASRM, doctors diagnose unexplained infertility, also called idiopathic infertility, in about 30 percent of infertility cases.
Other experts say the diagnosis rate is closer to about 15 percent, and the variance in these numbers often relates to differences of opinion as to what constitutes “comprehensive testing.” That’s because no fertility test or combination of tests can accurately identify all abnormalities that can cause unexplained infertility.
ASRM says that before doctors can make a diagnosis of unexplained infertility, both partners must have received traditional fertility testing that includes:
A diagnosis of unexplained infertility means that the fertility specialist must seek to pinpoint the cause of infertility by empiric methods, meaning using his or her experience and educated guesses based on clinical observations. Common attempts in this effort focus on sperm quality of the man, pelvic health and ovulation issues with the woman, and problems with the couple timing intercourse for optimum success.
Some of these treatments for unexplained infertility are listed below and generally fall under four categories: timing of intercourse, lifestyle factors, medications, and assisted reproductive technologies.
Fertility physicians often use clomiphene citrate (brand name Clomid) to treat unexplained infertility, as it can induce a woman’s ovaries to produce more than the normal one egg per menstrual cycle and thus increase chances of fertilization and pregnancy.
Clomid is often used in conjunction with improving intercourse timing or with intrauterine insemination (IUI), in which the male’s sperm is placed inside the woman’s uterus to promote pregnancy.
Gonadotropin (hormones similar to those produced normally by the woman) therapy involves increasing a woman’s gonadotropin hormone levels that promote egg production. As with Clomid, this results in multiple eggs being produced, although more aggressively. Physicians may also use this therapy in conjunction with IUI.
In IUI, a fertility specialist places prewashed sperm from the male partner directly into the woman’s uterus. This is done using a catheter that goes through the cervix into the uterus. IUI ensures that the increased numbers of sperm reach the top of the uterus and the fallopian tubes.
ART treatments used for unexplained infertility include IVF, which has been shown to be more effective than non-ART treatments described above. ASRM notes that live birth rates among women with unexplained infertility who use ART treatments are about 30-50 percent. But those percentages depend a great deal on the female partner’s age.
IVF involves creating embryos in the lab outside the woman’s body using her retrieved egg(s) and her partner’s provided sperm, then transferring the embryo to the woman’s uterus.
In addition, intracytoplasmic sperm injection (ICSI) may be used during IVF to help any sperm quality issues. This process injects the sperm directly through the egg’s outer core and into the cytoplasm area where fertilization actually takes place.
Risks of these treatments include reactions to medications, including ovarian hyperstimulation syndrome (an excessive response to the hormones) in women and possible issues arising from ART. These may involve damage to tissues and organs, risk of infection and potential damage to retrieved eggs or to embryos. Multiple pregnancy (such as twin or triplet pregnancy) can occur if more than one embryo is transferred. Current recommendations from ASRM and the Society for Assisted Reproductive Technologies (SART) emphasize the importance of transferring the fewest number of embryos that are likely to achieve a pregnancy.