Do you really have an unexplained infertility diagnosis?

This comprehensive guide on unexplained infertility explores its causes, diagnosis, and treatment options. We dive deep into the possible factors contributing to unexplained infertility, how it is diagnosed, and the various treatment options available for couples facing this challenge.

Introduction to Unexplained Infertility

Unexplained infertility is a term used when doctors cannot find a specific cause for a couple’s inability to conceive after conducting standard fertility tests. It affects approximately 10-30% of couples who struggle with infertility. This article will discuss the potential causes of unexplained infertility, how it is diagnosed, and various treatment options available for couples experiencing this frustrating situation.

Potential Causes of Unexplained Infertility

While unexplained infertility can be frustrating for couples trying to conceive, there may be various factors contributing to their difficulty. Some potential causes of unexplained infertility include:

Undetected Hormonal Imbalances

Hormonal imbalances can contribute to fertility problems. Although standard fertility tests often check for hormonal imbalances, some may not be detected. For example, subtle imbalances in thyroid hormones or insulin levels could impact fertility but may not be identified in routine testing.

Mild Endometriosis

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, causing pain and potential fertility issues. Mild endometriosis may not be detected through standard fertility tests but could still affect a woman’s ability to conceive.

Sperm Quality Issues

While sperm count and motility are typically assessed in fertility tests, other factors such as sperm DNA fragmentation or abnormal sperm morphology may not be evaluated. These issues can affect the sperm’s ability to fertilize an egg, leading to unexplained infertility.

Immune System Factors

In some cases, a woman’s immune system may mistakenly attack sperm or embryos, preventing conception. Additionally, inflammation caused by immune system disorders can negatively impact fertility.

Lifestyle Factors

Unhealthy lifestyle choices, such as poor diet, lack of exercise, and exposure to environmental toxins, can contribute to fertility problems. While these factors may not be directly measured in standard fertility tests, they can still impact a couple’s ability to conceive.

Diagnosing Unexplained Infertility

A diagnosis of unexplained infertility is typically made by a fertility specialist after a series of standard fertility tests fail to identify a specific cause for a couple’s inability to conceive. These tests may include:

Ovulation Testing

A variety of methods can be used to confirm if a woman is ovulating regularly, including tracking basal body temperature, monitoring luteinizing hormone (LH) levels using urine-based ovulation predictor kits, or performing blood tests to measure hormone levels (e.g., progesterone, follicle-stimulating hormone).

Semen Analysis

Semen analysis evaluates a man’s sperm count, motility, and morphology. This helps determine if there are any sperm-related issues that could be contributing to male infertility.

Hysterosalpingography (HSG)

This imaging test involves injecting a contrast dye into the uterus and fallopian tubes, then taking X-ray images to identify any blockages or structural abnormalities that could be affecting fertility.

Transvaginal ultrasound

Using a specialized probe inserted into the vagina, this imaging technique allows for the visualization of the ovaries, uterus, and fallopian tubes to check for any abnormalities such as cysts, fibroids, or adhesions.


A minimally invasive surgical procedure, laparoscopy involves inserting a thin, lighted tube (laparoscope) through a small incision in the abdomen. This allows the physician to visually examine the reproductive organs and identify any potential issues, such as endometriosis, adhesions, or tubal blockages.

Treating Unexplained Infertility

Treatment for unexplained infertility can vary depending on the couple’s unique situation and preferences. Some of the most common treatment options include:

Fertility medications

Drugs like clomiphene citrate (Clomid) or letrozole (Femara) can be prescribed to stimulate ovulation in women who have irregular or absent ovulation. These medications work by inducing the release of hormones that stimulate the ovaries to produce one or more mature eggs.

Intrauterine insemination (IUI)

In this procedure, specially prepared sperm is inserted directly into the woman’s uterus around the time of ovulation. IUI can be performed with or without fertility medications, and it helps increase the chances of conception by placing sperm closer to the egg, bypassing potential issues in the cervical mucus or sperm transportation.

In vitro fertilization (IVF)

IVF involves retrieving eggs from the woman’s ovaries, fertilizing them with sperm in a laboratory, and then transferring one or more embryos into the woman’s uterus. IVF can be an effective treatment option for unexplained infertility, as it bypasses potential issues related to fertilization, embryo implantation, or early embryo development.

Donor Eggs or Sperm

In some cases, couples may choose to use donor eggs or sperm to improve their chances of conception. This can be an option for those who have not had success with other treatments or who may have concerns about passing on genetic conditions.

Lifestyle modifications

Although not a specific treatment, making certain lifestyle changes can improve overall fertility and increase the chances of conception. These changes may include maintaining a healthy weight, adopting a balanced diet, exercising regularly, managing stress, quitting smoking, and reducing alcohol intake.


It is important to discuss the available treatment options with a fertility specialist to determine the best course of action based on the individual circumstances and medical history of each partner.