Making Sense of Unexplained Infertility: 8 Potential Causes
Unexplained Infertility is an aspect of one’s journey to parenthood that everyone hopes to never face. It can be an uncertain time, and it becomes increasingly difficult when a doctor says the words “unexplained infertility”. Such a diagnosis can be crushing, leaving you and your partner feeling helpless and out of control. Unlike other forms of fertility struggles, “unexplained” makes it very unclear as to why you are experiencing difficulty conceiving or what you can do to rectify it.
Statistically speaking, approximately 30% of couples worldwide are facing challenges surrounding unexplained infertility – this means physicians have not been able to properly identify concrete reasons as to why a couple cannot conceive.
With such high percentages of the population experiencing unexplained fertility issues and the medical community still encouraging the “wait-and-see” method – many partners have their infertility undiagnosed due to a lack of medical intervention. However, in recent years this has started to change for the better. Large numbers of researchers today have explored fertility and concluded that unexplained infertility simply means an explanation hasn’t been discovered.
(If you’re suffering from secondary infertility, check out our guide here).
With new research surfacing about fertility – and the struggles that can come with it-many possible causes have been identified for unexplained infertility. In this article, we have put together the below list of eight of the remarkably significant challenges of infertility and what they mean for your diagnosis.
What Is Unexplained Infertility?
Before we dive in, it’s important to understand what unexplained infertility is. Infertility has been defined as, “the inability to become pregnant after trying to naturally conceive for one year (or 6 months if you are over the age of 35)”. In total, it affects 12% of females worldwide – and it can also be caused by a medical problem, such as polycystic ovarian syndrome (PCOS) or endometriosis. However, oftentimes, physicians are not able to establish clear reasons as to why couples cannot become pregnant on their own. It may lead doctors to conclude that the couple is suffering from unexplained infertility for cases like this.
Ideally, physicians will say that such a diagnosis is one of exclusion – indicating that if a couple finds themselves not able to conceive, a diagnosis should be given to the couple following a complete workup on both the female and her male partner. A full infertility evaluation will include semen analysis, the test of ovarian reserves, a workup of ovulation tracking through the means of using ovulation tests, basal body temping and checking your cervical mucus and – in some cases laparoscopic surgery to get a full picture of the reproductive organs.
What Are The Odds of Conceiving With Unexplained Infertility?
Being diagnosed with unexplained infertility can be devastating, but it doesn’t always mean you will not be able to get pregnant. Some studies have even shown that many females with unexplained fertility troubles go on to become pregnant naturally based on certain lifestyle changes.
There was a six-month study revealed that 32% of females who did not receive any treatment were able to become pregnant with intrauterine insemination (IUI). Another study uncovered that managing expectations (also know as the “wait-and-see” approach) in women dealing with unexplained infertility was slightly more effective than administering Clomid.
Whether or not you and your partner choose fertility treatments or opt for a more natural approach, partners with unexplained fertility troubles do have a probability of conceiving. By seeking out a doctor’s counsel, you will have the help needed to decide which option is best for you while taking into consideration your age and overall health.
Idiopathic or Unexplained Infertility?
When exploring the varying aspects of fertility, it is important to note the different types of fertility issues that affect some couples. For example, when it comes to unexplained infertility, doctors will look at sperm quality, whether the woman is ovulating regularly by testing with OPKs, and will also perform something called a laparoscopy to determine if there is damage to the pelvic organs. If all of these tests come back clear and normal, then the cause of any infertility is said to be “unexplained”. In other words, partners are diagnosed with “unexplained infertility” when there is no medical reason why they are not able to conceive.
Alternatively, a doctor may discover changes in sperm quality or irregular ovulation but cannot be explained by another medical condition. This is known as “idiopathic infertility”. Strictly speaking, when the medical diagnostic finds hidden issues with a man’s sperm, physicians label it as “idiopathic male infertility” – for women, doctors will discover whether she is not ovulating when she should be. If it is for unknown reasons, doctors will give a diagnosis of “idiopathic female infertility.”
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Potential Causes of Unexplained Infertility
The very idea that one could offer up a “cause” of unexplained infertility seems to be counterintuitive as unexplained infertility is just that – unexplained. Having said that, more and more experts believe unexplained infertility is not truly unexplainable – rather, they feel it is caused by certain variables that haven’t been identified yet. Physicians and researchers have even started to theorize about what some of those possible causes may be.
Now that we’ve covered some terms and definitions used by the medical community, let’s start with the below list of eight probable causes physicians and researchers have identified for infertility, and we will discuss how these things impact your reproductive health.
It is amazing what little changes in diet can do for one’s overall health – but what’s even more amazing is how healthier choices can impact a woman’s fertility journey. For example, folate, iron, and vitamins D, C, and B12 are the building blocks of fertility, which, interestingly enough, are also the building blocks for a fetus as they are growing inside of the womb. These vitamins and supplements help maintain egg health, especially as females age, along with ensuring your ovaries are timing the release of your eggs properly. Hence, they’re more likely to be fertilized.
Studies have also shown that females who are anemic (i.e. deficient in iron, vitamin B12, or both) are at risk for having anovulatory cycles – and almost 50% of women who are deficient in vitamin D (where the levels measure below 0ng/ml) are not able to get pregnant.
But there is good news about all of this. A Harvard study has discovered that women who changed just five lifestyle factors, one of which is shifting to a fertility diet, saw an 80% reduction in fertility struggles due to ovulatory disorders.
Genetics also plays a key role in a couple’s journey with infertility. A portion of one chromosome will have been transferred to another (translocation) with chromosomal polymorphism, or a piece of a chromosome has been inverted. If you have either of the aforementioned conditions, but your partner does not, the genetic material carried within your egg and his sperm, unfortunately, won’t be able to combine.
Affecting roughly 4% of the population, chromosomal polymorphism is disproportionately present in partners diagnosed with unexplained infertility – according to one 2017 study. But there is good news; researchers believe that if you and your partner have the same chromosomal polymorphism, it will not affect your fertility at all.
This is one of the key factors that used to be overlooked by the medical community, which has – in recent years – come to light. Researchers at Queen’s University Belfast performed tests on sperm from males in a couple who had been diagnosed with unexplained infertility. The study discovered that 80% of them had “DNA-damaged sperm.” To be frank, most of the male population has a little bit of DNA damage in their sperm. However, as long as the damaged sperm make up less than 15% of the total supply, there’s no effect on fertility.
4. Mild Endometriosis
Technically speaking, someone diagnosed with endometriosis will not (technically) be placed under an umbrella of “unexplained infertility.” However, physicians may find that mild forms of endometriosis to be more difficult to diagnose, even with diagnostic laparoscopy. This may result in you being given an “unexplained infertility” diagnosis when really, the problem is Stage I or Stage II endometriosis.
Another diagnostic tool is laparoscopy. This particular exploratory surgery is used to aid in diagnosing endometriosis. While performing this exploratory surgery, Most physicians look for the characteristic “gun-powder” lesions that are black, dark brown, or blue. But, as with anything medical, other anomalies make it harder to detect endometriosis. Other characteristics would be legions that are red or even clear, making it harder to see with the naked eye. If a surgeon performing the laparoscopy is not professionally trained to specifically spot, diagnose and treat endometriosis, as it can be easy to miss these more atypical endo lesions during surgery.
5. Tubal Damage
This particular aspect of infertility can be easily missed. Tubal infertility, or TFI, refers to when fallopian tubes are blocked by scar tissue – otherwise known as adhesions. These adhesions can be created by endometriosis, pelvic inflammatory disease, or another medical condition.
In recent years, quite a few physicians have been using a form of imaging called HSG (hysterosalpingogram) to identify TFI properly. For an HSG, a dye is implanted into the uterus for the fallopian tubes to become illuminated upon taking an x-ray. By using this particular method, doctors can more easily procure potential blockages of the fallopian tubes.
Even if an HSG does not detect that your tubes are not blocked, there may still be some adhesions that cannot be seen on this test. So, if your doctor does not also perform a laparoscopy to create a better visual of potential adhesions, TFI can be missed – which means you might be stuck with a UI (unexplained infertility) diagnosis.
6. Premature Ovarian Failure
Primary ovarian insufficiency or otherwise known as POI occurs when the woman’s ovaries stop functioning normally before reaching the age of 40. Unfortunately, with POI, 90% of cases remain undiagnosed.
One of the “benefits” of POI is that it is still possible to conceive naturally. But it should be noted that certain genetic disorders, diseases, and cancer treatments make it more likely for a woman to develop POI. However, if a woman has been diagnosed with POI, but the cause is still unknown, it could be related to lifestyle factors. If this is the case, some simple improvements should see this diagnoses turn itself around, and you may get pregnant. One of the key factors in conceiving (even when diagnosed with POI) is diet.
7. Immunological Infertility
Falling one again under the umbrella of an internal issue, II creates an autoimmune response to sperm, one that may be present in either the male or female or both. But what is immunological infertility (II)? If someone is diagnosed with II, this means their body creates more ASA (anti-sperm antibodies) than the average human. Unfortunately, this means ASA can pillage sperm, either within the female body before the sperm can combine with an egg or within the male individual before ejaculation.
8. Egg Quality
This aspect of fertility tends to be one the most recognized amongst those dealing with or helping support someone amid their fertility journey. Though people used to assume that any issues conceiving were only due to egg quality, that’s a common misconception. Though it is possible, it no longer is believed to be the main reason for infertility.
So what is the real issue with egg quality? For women, it simply isn’t enough to just ovulate each month; the egg being released also has to be of high enough quality to be fertilized and implanted within the womb. Because of genetic mutations, low-quality eggs are not able to be fertilized, and the amount of “genetically abnormal eggs” increase in regularity as women age.
The timeline for when egg quality declines happens over the age of 35. But, it can also be affected and subsequently controlled by certain lifestyle factors such as diet, environmental toxins, and psychological stress. Therefore, if egg quality issues cause your unexplained infertility, you may be able to improve your egg quality by addressing these factors.
Getting Help vs. Making Lifestyle Changes
The key factor in working with an infertility diagnosis, be it unexplained or for a medical reason, is to do your research. Yes, physicians and specialists can be a wealth of information, and it’s important to speak with them often to ensure you are getting the answers you need. But you can also go to bat for yourself by engaging with other research, getting a second medical opinion, speaking with a nutritionist to tackle lifestyle changes and work towards incorporating exercise into your daily life.
Furthermore, with unexplained infertility, many physicians are still using a “wait-and-see” approach. So, be sure to ask yourself this question before beginning to wrack up those medical costs, “is there anything I can do about unexplained infertility before visiting my doctor?”
Important Factors To Make Note Of about unexplained Infertility:
If you have been trying to conceive for over one year (or six months if you are over age 35) but have not yet seen a fertility specialist, you should be making an appointment with your physician. Seeking out an official diagnosis, even if it’s “you have unexplained infertility”, can still open a door for you to learn specific types of lifestyle changes that can aid in you conceiving naturally.
Moreover, if you have officially been diagnosed with unexplained infertility and given a prescription of “wait-and-see”, you may want to look into your diet, possible environmental exposures and even take a deep dive into your stress levels as psychological stress can hinder fertility.
In the end, regardless of the diagnosis, infertility is a very unique, personal, and not always a straightforward road to travel. Thankfully, the medical community is also becoming more and more fluent in the language of fertility, and they are certainly becoming more and more willing to seek out answers for those struggling. Fertility struggles are something no one ever wants to face, but with the medical world making such great strides to diagnose properly and guide you through your journey, you will be well taken care of. Remember, an infertility diagnosis does not define you; it is simply the next step in your journey towards becoming a parent.