UNEXPLAINED FERTILITY: WHAT EXACTLY MEAN?

Infertility on its own is a frustrating experience. From trying to conceive through to testing and diagnosis, it involves many stages and challenges. A diagnosis of unexplained infertility may make the frustration you feel even more intense. Where do you go from there? How do you and your fertility specialist move beyond a diagnosis of unexplained infertility? Unexplained infertility is a very real diagnosis, and there is treatment. It is estimated that 5%-10% of couples facing infertility receive a diagnosis of unexplained infertility. Although treatment is not as demanding as when a known condition is being treated, your fertility specialist will guide you through a course of action that improves your chances of a successful pregnancy.

How is unexplained infertility defined?

Unexplained infertility occurs when standard infertility tests are inconclusive and cannot identify the cause of the inability to conceive. After a fertility specialist has carried out a comprehensive series of tests and has been unable to identify the cause, the patient's diagnosis is considered unexplained. Some doctors may refer to unexplained infertility as idiopathic infertility; however, that term is usually used for infertility that is unexplained but is limited to a male or a female factor.

Tests for infertility

According to the American Society for Reproductive Medicine and the National Institutes of Health, doctors cannot reach a diagnosis of unexplained infertility until the patient or patients have had a thorough assessment and the standard fertility tests. These tests include:

• A thorough physical examination
• A complete medical history and a complete sexual history
• Assessment of the woman's ovulation
• Assessment of the woman's ovarian reserve
• Semen analysis for the man
• Assessment of the woman's uterus and fallopian tubes (hysterosalpingogram)
• Further tests include a laparoscopic procedure to examine the reproductive organs. Although minimally invasive, your doctor performs this procedure to see and confirm a suspicion of endometriosis, adhesions or scar tissue, ovarian cysts and uterine fibroids.

Diagnosing unexplained infertility

A diagnosis of unexplained infertility is made when both the man and the woman have had a full and comprehensive series of tests and the results show that-

• They are both physically healthy
• Ovulation is regular
• The egg reserve appears healthy
• The fallopian tubes are clear, open and healthy
• There are no problems with the uterus
• The semen analysis is normal for sperm count, motility and shape

Causes of unexplained infertility

Unexplained infertility is, by definition, the inability to identify the reason for a couple's unsuccessful attempts to conceive. Because medical tests are imperfect by nature, it is possible that they have missed some subtle signs or defects.

Mild endometriosis is difficult to diagnose. Severe endometriosis can lead to painful periods. Endometriosis often prevents the egg from passing into the fallopian tube, or even prevents ovulation itself. With mild endometriosis, however, you may have no distinct symptoms, and it may be present only to the extent that it interferes with conception.

Poor egg quality is another possible cause of unexplained infertility that is also easily missed. The closer you are to the age of menopause, the less viable your eggs may become. Some underlying medical conditions also result in poor egg quality.

Sperm quality can also be the cause of unexplained infertility. Even when the sperm count, motility and morphology are normal, sperm DNA problems are more common in older men. Often, when both the egg and the sperm appear healthy but fertilisation simply does not happen, this may point to a problem with egg or sperm quality. There is also the possibility that the sperm fertilises the egg but the cells fail to develop and form an embryo.

Luteal phase defect is another possible cause of infertility as well as of recurrent miscarriage. The luteal phase is a stage of a woman's menstrual cycle that occurs after ovulation but before the period. After ovulation, the ovaries produce the hormone progesterone. The uterus responds to this hormone by thickening its lining. If you are not pregnant, the lining is shed with your period. If your egg is fertilised, it implants in the lining of the uterus. If your uterus does not respond to progesterone, a fertilised egg cannot attach and develop.

Treatment for unexplained infertility

Every experience of unexplained infertility, without knowing the exact single cause of the infertility, is clearly harder to treat. However, there are some common treatments that are often successful in such cases.

• Timed intercourse: The fertility specialist teaches the couple how to time intercourse with the woman's ovulation for the best chances of conception. This is a particularly successful treatment for young couples.
• IUI (intrauterine insemination) is performed when the fertility specialist collects, washes and concentrates the sperm and then places it directly into the woman's uterus at the time of ovulation. Using medication to stimulate ovulation, or injections, increases the chances of pregnancy.
• IVF: IVF is the most effective treatment for unexplained infertility. The laboratory creates embryos from the couple's eggs and sperm and can test the embryos for viability and chromosomal abnormalities before the embryo(s) are transferred.

Your partner in overcoming infertility

Assisted reproductive technologies, and reproductive medicine in general, are constantly striving to improve the odds against infertility. We understand how frustrating a diagnosis of unexplained infertility can be, and we work closely with our patients to help them grow their family the way they have dreamed of. Always guided by each person's individual needs and with up-to-date information, we stand by you with respect and empathy on your fertility journey. Contact the Alexandros Traianos Reproductive & Fetal Medicine Centre by calling (+30) 2310 277 032 or by filling in the contact form. We are here with the answers you need!