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Unexplained Infertility: Understanding the Diagnosis & Treatment

Unexplained Infertility: Understanding the Diagnosis & Treatment

Receiving the diagnosis of unexplained infertility when you are ready to have children can be frustrating. To make matters worse, It is also common to be diagnosed with unexplained infertility.

Approximately one in four fertility-challenged couples are told that there isn’t an explanation for why they cannot conceive. However, unexplained infertility doesn’t necessarily mean that the couple has no options, so you shouldn’t give up when you are in this predicament.

What are the chances of getting pregnant with unexplained infertility?
What are the chances of getting pregnant with unexplained infertility?

Depending on the period you have been trying, and your age, the odds of getting pregnant on your own are higher than for many infertility diagnoses. Research involving 1,376 women with unexplained infertility in Australian women aged 28 to 36 years revealed that 43% of those who didn’t receive fertility treatment managed to conceive and give birth.

This piece will be sharing what an unexplained infertility diagnosis means, what it doesn’t, and any explanations for the unexplained. Keep reading to know more and where to get help on your unexplained infertility journey in Australia. 

Is your infertility unexplained?

For many years, unexplained infertility has been a controversial diagnosis because, by definition, it is an elimination diagnosis. Usually, it means that your doctor has determined that you do not have all the health problems that could cause you not to conceive, yet you cannot get pregnant. But, while your physician may diagnose your health case as unexplained, a fertility specialist might say that you haven’t been evaluated thoroughly and that the doctor would be right.

Unexplained infertility is truly diagnosed after undergoing a complete fertility evaluation for both you and your spouse or partner. This diagnosis is only justified once it is revealed that:

  • You ovulate regularly
  • There aren’t severe uterine fertility issues (checked with a hysteroscopy)
  • The fallopian tubes are healthy and open (evaluated with an HSG)
  • A semen analysis proves that your partner has healthy sperms (they consider the sperm movement, sperm shape, and total count)
  • Ovarian reserves are excellent (it’s checked with blood work or antral follicle count)

Therefore if any of these tests haven’t been done, providing an unexplained infertility diagnosis could be premature. Some health care providers argue that laparoscopy is also required to rule out endometriosis, and this condition cannot be diagnosed without ultrasound or blood work. With that said, unless you are experiencing painful periods, the doctor will not consider the risks of the surgical laparoscopy to make a diagnosis. (Additional information on endometriosis as a cause of unexplained infertility will be explained below).

Idiopathic verses unexplained male or female infertility

It’s crucial to understand that unexplained infertility isn’t the same as idiopathic male or female infertility. Generally, idiopathic means unexplained, but when the doctor mentions idiopathic male infertility, they have determined that the man is infertile. This means that his semen analysis results weren’t normal.

Why do some men get semen analysis results that aren’t normal? The truth is that this might not be known. Whenever the doctor cannot determine the cause, they’ll likely say the man has idiopathic male infertility. On the other hand, idiopathic female infertility can occur whenever a woman is not ovulating normally or regularly. Still, it isn’t clear why ovulation is not happening when it needs to.

In these two examples, it is known why the man or woman cannot conceive – why she is not ovulating or why his semen is not in the fertile range. But with unexplained infertility, the sperm are fine, and ovulation is happening regularly, but the couple isn’t getting pregnant.

Possible explanations for unexplained infertility

One of the critical things you need to know is that unexplained infertility is not magical. There are reasons behind it, and we do not know them yet. Several things can cause problems, but we do not have a suitable way to evaluate or measure them yet. Here are various possible explanations linked to unexplained infertility.

Mild endometriosis & unexplained infertility

Severe endometriosis has a high chance of causing fertility problems that can be noticed even without laparoscopy. For instance, endometrial cysts can interfere with ovulation or lead to fallopian tube blockages.

On the other hand, mild endometriosis might not interfere with ovulation or egg passage, and it might also not have any apparent symptoms. While endometriosis may be responsible for some of the unexplained infertility cases, experts disagree on whether infertility can be caused by mild endometriosis. They also don’t know if laparoscopic surgery and reprove endometrial deposit is vital.

Undiagnosed underlying condition

Having an undiagnosed underlying medical condition can have an impact on your fertility. However, medical experts do not entirely understand how poor health affects fertility in measurable ways. The good news is that they are learning more and more by the day so that things could be more evident in the near future. For instance, untreated celiac disease can cause unexplained infertility.

A reanalysis of previous studies done in 2016 has found that celiac disease can be diagnosed about six times more often in women with unexplained infertility than in healthy ones. The authors noted that previous studies were not done extensively, so it’s difficult to know exactly how accurate the odds are. What’s more, it appeared that women with different types of infertility are likely to be diagnosed with celiac. 

Additional underlying conditions that can cause infertility include undiagnosed thyroid disorder, diabetes, and some autoimmune illnesses.

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Sperm and vaginal environment

After ejaculation, the sperms make their way out of the semen into cervical mucus. Once they get there, they will swim up into the cervical opening, heading into the uterus. Several problems can occur during this transition period, affecting the sperms, hence reducing the chances of getting pregnant. For instance, antibodies in the cervical mucus could attack the sperm, also known as the hostile cervical mucus. The effective way to diagnose the problem is unknown, as such cases are categorized as unexplained infertility.

Poor egg quality & unexplained infertility

Currently, you can get test kits to determine your fertile window. When you know the ovulation period, you can get testing to determine whether the quantity of eggs you have in your ovaries is relatively good. However, there isn’t a test you can do to determine if you have good quality eggs.  

Poor quality eggs can be caused by an underlying medical condition, age, and other unknown causes. Luckily poor egg quality can be diagnosed when taking IVF treatment. Once the egg is retrieved, it can be examined under a microscope to determine if you can have children or not.

Poor sperm quality & unexplained infertility

Sometimes a man can have recognizable poor sperm quality problems that can affect conception. For instance, if the sperm’s shape is poor (morphology), it will likely cause fertility problems. Moreover, sperm movement or motility is also known for causing infertility. These two conditions are diagnosable and will be noticed during a sperm analysis. However, other issues related to sperm quality cannot be spotted during personnel analysis.

For instance, the sperm might have poor-quality DNA. The DNA issues usually increase as the man grows older, and that’s why kids born of older fathers are at a higher risk of developing some birth disorders or mental health problems. Therefore, if good-looking sperm don’t fertilize a healthy-looking egg, it could mean that there’s a problem with the sperm or egg quality.  

Endometrium problems

It’s possible to have healthy eggs, sperms, and a healthy cervical environment, but problems if the resulting embryo is healthy but cannot impact the endometrium. The possible reasons that cause fertility problems linked to the endometrium are unknown.

One study published in 2016 revealed that a newly discovered virus which is a part of the Human Herpesvirus virus family (HHV) and often found in the endometrial tissue in women, could be responsible. However, it is not yet known how this problem can be diagnosed or treated. What’s more, luteal phase defects are possible problems that could affect the endometrium leading to unexplained infertility cases.

Issues of the fertilized egg

If you have healthy-looking sperm and egg as a couple, then they will form to become an embryo. The cells in the embryo are opposed to dividing and growing to form the uterus, but sometimes things don’t always go as planned. This problem can be diagnosed when you seek IVF treatment since embryos can be monitored to determine normal cell division.

Nothing could be wrong

A couple with unexplained infertility can conceive without treatment within two years of diagnosis. Nobody knows why this happens or what’s wrong, but it is common. A fertile couple usually has a 25-30% chance of getting pregnant each month. As you can see, the odds are not 100%, so no one has a 100% chance of conceiving.

There could be a chance that you have a subtle fertility problem but still have a chance of conceiving on your own over time. Also, you and your partner could have seriously bad luck. Such situations can be frustrating, but they are a possible explanation for couples who have been trying to conceive for about two to three years unsuccessfully.