The term “unexplained” infertility sounds worse than it is. Frequently couples feel when they have this diagnosis that there is no defined problem and therefore no available treatment. That is really not the case! First let us discuss “explained” infertility.
“Explained” infertility is when we know the cause of the condition. This could be ovulation problems, tubal scarring or male factor infertility. This has usually been determined after some diagnostic workup. The most basic work up would be testing ovulation with blood work or ultrasound. Also a test of sperm function such as a semen analysis would be completed. Finally some test of tubal function such as an x-ray of the uterus ( hysterosalpingogram or HSG) or sometimes an ultrasound HSG. In some cases laparoscopy is performed to evaluate scarring or endometriosis. Laparoscopy is done through a belly button incision and involves direct visualization of the reproductive tract. Once the cause is explained we can begin targeted therapy.
If the work up has been completed and no abnormality defined then we would say that we have diagnosed “unexplained” infertility. At this point if laparoscopy has not been previously performed, it may be an option to evaluate for scarring of the tubes or endometriosis.
Treatment for unexplained infertility includes ovulation induction and insemination and in vitro fertilization. Ovulation induction and insemination can be done with oral or injectable meds. Oral drugs such as Clomid or Femara are simple inexpensive and often chosen as first line options. It is important to know that the medication alone is not very effective. Also insemination in unmedicated cycles is notoriously ineffective. The combination of the meds plus the insemination is more effective. If the oral meds plus insemination don’t work you can move to injectable meds such as Gonal F or Follitim plus insemination and get more pregnancies. These drugs have better properties but can increase the chance of multiples.
In Vitro Fertilization (IVF) is the other option. IVF because it bypasses essentially all barriers produces very high pregnancy rates in the shortest period of time. Because IVF ensure the meeting of the egg and sperm and we know that the embryo is being placed in the uterus success rates are higher than with other therapies.
The odds of success with unexplained infertility depend on the age of the woman and how good the ovarian reserve is. Ovarian reserve is best estimated by antral follicle count or AMH level.
Please do not be discouraged if you have this diagnosis. It is associated with an excellent prognosis. For best results, we suggest early diagnosis and treatment.