Unexplained Infertility

Unexplained infertility at a glance

  • Unexplained infertility is the default diagnosis when evaluations of an infertile couple or person find no specific cause of the infertility and show that the woman’s fallopian tubes and ovulation are normal and the man has healthy sperm.
  • According to the American Society for Reproductive Medicine (ASRM), up to 30 percent of couples struggling to conceive are diagnosed with unexplained infertility.
  • The first steps in treating unexplained infertility are a complete health history and physical exam of both partners.
  • Other treatment options include ovulation induction, lifestyle changes, intrauterine insemination (IUI) and in vitro fertilization (IVF).

What is unexplained infertility?

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:

  • Complete medical history and sexual history.
  • Physical exam.
  • An assessment of the woman’s ovulation and her ovarian reserve.
  • Analysis of the man’s semen.
  • A hysterosalpingogram, which is an X-ray of the woman’s uterus and fallopian tubes to determine whether they are normal.

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.

Treatments for unexplained infertility

Fertility specialists may base treatment options for unexplained infertility on results of previous tests and observations. In some cases, a couple with unexplained infertility may conceive after testing without being treated at all. In others, fertility experts may try a variety of treatments.

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.

Improving timing of sexual intercourse

Timing of intercourse is crucial for conception, particularly for couples experiencing unexplained infertility. Fertility doctors can counsel couples on how to calculate the woman’s ovulation to time intercourse accordingly.

Lifestyle changes

Managing weight to prevent obesity, being overweight or being underweight – all potential factors in male and female infertility – can be beneficial. Doctors recommend at least 30 minutes of exercise each day to help maintain weight and to reduce stress. A healthy diet is also beneficial to maintaining a normal weight. Although controversial, the physician may recommend limiting alcohol and caffeine intake.

Medications

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.

Assisted reproductive technologies (ART)

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.