Unexplained Infertility Explained

Nearly all infertility patients come to a fertility clinic wanting to get pregnant and understand why they have not been able to conceive. Although in most cases, particularly those under 40 years old, we are able to help patients achieve a successful pregnancy, there are instances we are not able to find an exact cause of infertility. While receiving a diagnosis of unexplained infertility can be frustrating, it is actually very common and does not mean there aren’t options. Patients come to see us to have their unexplained infertility explained.

If all the standard testing turns out to be normal, the patient meets the criteria for the diagnosis of unexplained infertility. It is important to acknowledge that unexplained infertility can diagnosed after a full fertility evaluation of both the female and male partner. For the female partner, the testing is scheduled according to their menstrual cycle. The testing includes:

It is common for all these tests to come back as normal. For some patients, this can be very discouraging. However, as a reproductive endocrinologist, I know there is a high chance that a patient will be able to conceive if all the testing on a patient is normal, especially in women under age 40. Unfortunately, in this age group, infertility is probably due to aging eggs in the ovary. I do reassure women <age 35, with the presence of some sperm, healthy eggs, and a normal uterus, there is an 80-90% chance that we can help them have a child.

Some of the reasons these patients can not conceive despite normal testing are the following:

Most common treatments for unexplained infertility are using a fertility drug with intrauterine inseminations (IUI) or in vitro fertilization (IVF). Most couples who come in have been timing intercourse adequately but simply have not been successful in conceiving. Using a fertility drug, such as Letrozole or Clomid, and monitoring the patient closely, then performing intrauterine insemination with washed concentrated motile sperm can increase the chance of pregnancy in women aged 35 and younger. However, after this age the chance of this treatment helping is less than 10%. Even in younger women, after 2 to 3 cycles, only one in five patients will be pregnant.

In vitro fertilization with embryo transfer success rates in women under 38 approaches 50% per cycle, and therefore, after two or three embryo transfers, nearly 90% of women will be pregnant. Even in women 38-39, most women will conceive after 2 to 3 embryo transfers. The decision to undergo 1-3 IUIs with medication versus going directly to IVF depends on many factors and should be discussed with your infertility doctor at FCNE. Besides higher success rates, another advantage of doing IVF rather than IUI is that most will have frozen embryos, such that, if they have one child via IVF and have frozen embryos, they can come back after having a child to use their frozen embryos. Most insurances in Massachusetts allow women of all ages to undergo IVF rather than an IUI if they meet the criteria for infertility.

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