Infertility, in itself, is a frustrating experience. Starting from trying to conceive to tests and diagnosis involves several stages and challenges. A diagnosis of unexplained infertility may make the frustration you feel even more intense. How will you continue from there? How do you and your fertility specialist overcome a diagnosis of unexplained infertility? Unexplained infertility is a very real diagnosis and there is treatment. An estimated 5%-10% of couples experiencing infertility receive a diagnosis of unexplained infertility. Although treatment is not as demanding as when treating a known condition, your fertility specialist will guide you through a course of action, improving your chances of a successful pregnancy.

How is unexplained infertility defined?

Unexplained infertility occurs when routine infertility tests are inconclusive and cannot identify the cause of the inability to conceive. After a fertility specialist runs a comprehensive series of tests and is unable to identify the cause, the patient's diagnosis is considered unexplained. Some doctors may refer to unexplained infertility as idiopathic infertility, but this term is usually used to refer to infertility that is unexplained, however, is limited to a male or 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 receive a thorough evaluation and routine fertility testing. These tests include:

• A thorough physical examination
• Complete medical history and complete sexual history
• Evaluation of the woman's ovulation
• Evaluation of the woman's ovarian reserve
• Analysis of man's semen
• Evaluation 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 suspected endometriosis, adhesions or scar tissue, ovarian cysts, and uterine fibroids.

Diagnosis of unexplained infertility

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

• They are both physically healthy
• Ovulation is regular
• The egg supply looks healthy
• Fallopian tubes are clear, open and healthy
• There are no problems with the uterus
• Sperm analysis is normal for sperm count, motility and shape

Causes of unexplained infertility

The definition of unexplained infertility is the inability to determine the reason for a couple's unsuccessful attempts to conceive. Due to the imperfect nature of medical examinations, there is a possibility that these examinations may have missed some subtle indications or defects.

THE mild endometriosis it is difficult to diagnose. A severe endometriosis can lead to painful periods. Often endometriosis prevents the egg from passing through the fallopian tube or even ovulation itself. But with mild endometriosis you may not have any distinct symptoms and may be present only enough to interfere with conception.

THE poor egg quality is another possible cause of unexplained infertility that is also easy to miss. The closer you are to menopause, the less viable your eggs may become. Certain underlying medical conditions also result in poor egg quality.

THE sperm quality it can also be the cause of unexplained infertility. Even when sperm count, motility and shape are normal, sperm DNA issues are more prevalent in older men. Often, when both the egg and sperm look healthy, but fertilization just doesn't happen, this could indicate a problem with the quality of the egg or sperm. There is also the possibility that the sperm will fertilize the egg, but the cells will fail to develop and form an embryo.

The luteal phase defect is another possible cause of infertility as well as multiple miscarriages. The luteal phase is a stage of a woman's menstrual cycle that occurs after ovulation but before a period. After ovulation the ovaries produce the hormone progesterone. The uterus reacts to this hormone by thickening the lining. If you are not pregnant, the investment is eliminated with your period. If your egg is fertilized, it implants in the lining of the uterus. If your uterus doesn't respond to progesterone, a fertilized egg can't attach and grow.

Treatment for unexplained infertility

Any experience with unexplained infertility is not knowing exactly the unique cause of infertility, it is clearly more difficult to treat. However, there are some common treatments that are often successful in such cases.

• Timed intercourse: The fertility specialist educates the couple on how to time intercourse with the woman's ovulation for optimal chances of conception. This is a particularly successful treatment for young couples.
• THE IUI (intrauterine insemination) 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 the drug to stimulate ovulation or injections increases the chances of pregnancy.
• IVF: IVF is the most effective treatment for unexplained infertility. The lab creates the embryos from a couple's egg and sperm and can check the embryos for viability and chromosomal abnormalities before the embryo(s) are implanted.

Your partner in overcoming infertility

Assisted reproductive technologies and reproductive medicine in general are constantly trying 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 raise their dream family. Always mindful of 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 Center for Reproductive Medicine & Fetal Medicine Alexandros Traianos by calling (+30) 2310 277 032 or by filling out the relevant contact form. We're here for the answers you need!