Explaining “Unexplained” Infertility

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Unexplained infertility does not mean nothing is wrong – that is is Myth #2 when it comes to infertility. Myth #1 is that infertility is a women problem, but I will leave that subject for another blog!

This message it is not only wrong, but can be very dangerous and lead to a delay in starting treatment, which is turn decreases a couple’s chance of success.

Unexplained does not mean that everything is fine, it means that the problem is there, but we cannot see it. It means that medicine is not able yet to identify the problem with basic screening tests or even sometimes with the most sophisticated ones.

Let’s start putting things into the right perspective: even young fertile couples who have no issues getting pregnant, only have about 25% chance of achieving pregnancy on any given month they try. In other words, they are unsuccessful 75% of the time! Getting pregnant is not so easy after all!! This is the data we see looking at the success rate of thousands of couples who start the journey to build their family. Most of these couples will achieve pregnancy within the first year of trying, but others may take longer or never achieve pregnancy at all.

Infertility is defined as the inability to become pregnant after a year of unprotected intercourse. If pregnancy is not achieved within this time frame, then you must seek specialised medical advice. When couples come to a fertility specialist, they want answers!

The first step is a detailed evaluation of the couple. Almost 75% of the time an issue is identified, but about 25 % of these couples will get a very unsatisfying result: unexplained infertility.

Among couples with unexplained infertility, we also know that despite all of the normal diagnostic testing only less than 2% of them will achieve a successful pregnancy without help.

Unexplained infertility is frustrating for couples and their doctors. Without a clear reason, a clear diagnosis, it is difficult to choose the right treatment.

Normally, in women less than 35 years old, the first line of treatment is IUI (Intra Uterine Insemination) with ovarian stimulation but every time you drive the ovaries to produce more eggs, especially in young women, you run the risk of “super-ovulation,” or making many eggs available for fertilization. This in turn means you run the risk of a “multiple pregnancy”. Three different kinds of medications are available for this purpose with similar results. In fact, a study published last year in The New England Journal of Medicine compared three drugs commonly used to treat unexplained infertility but unfortunately, there was no clear winner in terms of success rate or risk of multiple pregnancy.

A large randomized trial on couples with unexplained infertility, called FASTT, showed that couples who are unsuccessful after 3 cycles of intrauterine insemination (IUI) with ovarian stimulation should proceed to IVF (in vitro fertilization) as their next treatment. These couples will more likely become pregnant sooner and will therefore spend less money on fertility treatment.

If the women is older than 35 years old, the best advice is to proceed straight to IVF to help them attain their family goals. Often, subtle infertility factors can be seen during IVF and IVF then becomes a very powerful diagnostic tool. Even women with excellent ovarian reserve can have inadequate egg quality – which sometimes can be observed under the microscope after egg retrieval or have a low maturation rate. Couples with normal semen parameters may have poor fertilization rate, that means that the sperm may be unable to penetrate the egg. Another problem can be poor embryo development after fertilization, which can only be seen during IVF… and sometimes the issue is implantation.

All these are diagnostic benefits of IVF that cannot be detected in any other way. In addition, once the problems are identified, there are many options for overcoming these infertility factors modulating and personalising treatment with the assistance of reproductive technology. With IVF, moreover, the risk of multiple pregnancy can be minimized controlling the number of embryos transferred.

Although IVF does not fix all infertility factors, it can “fix” many of them and it is definitely the most successful treatment option for many couples.

So if you have been diagnosed with unexplained infertility do not “keep trying” indefinitely, but seek a fertility specialists advice to help you to achieve your goal and remember, the true goal of couples and their doctors isn’t just a pregnancy, but a pregnancy with a good outcome—a healthy mom and a healthy baby.

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