Infertility is a play of various factors. Age, weight, alcohol, and tobacco use are the primary causes of infertility. Doctors often attempt to understand the underlying reason behind infertility before recommending treatment. In cases where infertility fails to have a cause, this is what doctors call Unexplained Infertility.
What is Unexplained Infertility?
Unexplained Fertility, also known as idiopathic fertility, is an infertility case with no cause or explanation behind its occurrence. Couples who try to get pregnant for a year receive this diagnosis after standard infertility testing. Statistics show that approximately 30% of couples with infertility are diagnosed with unexplained infertility, making it one of the biggest causes of infertility.
Unexplained infertility is diagnosed after both couples are evaluated for infertility. The problem could lie with any of the partners, for instance, an obstructed fallopian tube for the female or a poor sperm count in the male. However, when nothing shows up during your standard infertility testing, then you’re most likely experiencing unexplained infertility.
The Good News
Unexplained infertility is treatable. Some doctors call it undiagnosed infertility since it is likely to get a diagnosis after further testing. Statistics show that women with unexplained infertility are likely to be diagnosed with conditions that impede pregnancy.
Possible Causes of Unexplained Infertility
While unexplained infertility has no cause, there are possible reasons for its occurrence. These are also referred to as unexplained infertility symptoms. They include the following:
Cervical Mucus Problems
Cervical mucus plays a key role during conception. The mucus thins during ovulation, acting as a medium to help the sperms swim through. A thick cervical mucus makes it harder for sperm to swim up to the egg. Moreover, your cervical mucus could further contain certain additives that impair this process.
A severe form of cervical mucus problem is known as hostile cervical mucus. This is characterized by acidic vaginal secretion or extreme vaginal dryness.
There are various reasons for having issues with your cervical mucus. In spite of that, with each menstrual cycle, your level of cervical mucus fluctuates. Furthermore, as you age, your cervical mucus levels become less abundant. Notably, some medications affect your cervical mucus causing it to dry up or decrease in quality.
Endometriosis
Endometriosis is a painful and common condition. The condition affects 2 to 10% of women between the age of 25 to 40 years. Endometriosis occurs when the tissue, similar to your uterus’ lining, grows outside the uterus leading to severely painful periods. Moreover, endometriosis can also cause infertility.
To shed more light on this, the endometrium is your uterus’ inner lining. During menstruation, this lining is what is shed off. Also, the lining gives support to the embryo during the early stages.
With endometriosis, endometrial-like tissue develops on organs and other structures in your pelvis, abdomen, or chest. Other places where you can develop endometriosis include:
- Vagina
- Ovaries
- Fallopian tubes
- Intestines
- Bladder and uterus
- Diaphragm
- Rectum.
The abnormally implanted tissue acts as it would in the uterus during your menstrual cycle-it thickens, disintegrates, and bleeds. However, with no way of leaving your body, it becomes stuck. Besides, the endometrial tissue becomes inflamed during menstruation, leading to the onset of superficial lesions, ovarian cysts, adhesions, or scar tissue.
Mild cases of endometriosis can result in infertility. However, the good news is there are effective treatments to counteract the condition.
Poor Egg Quality
Your egg quality plays a crucial role in conception. Most women only know about egg quality once they start their TTC journey. Generally, your doctor estimates the number of eggs you have through an ultrasound. However, this test doesn’t effectively show the state of your eggs. An AMH (Anti- Mullerian Hormone) test gives a clear picture of the quality of your eggs.
A diminished ovarian reserve is the primary cause of poor egg quality. This is mainly seen in women above the age of 35. As you grow older, your ovary reserve decreases with every menstrual cycle. This further translates to poor embryo quality and chromosomal abnormalities leading to congenital disabilities.
Poor Sperm Quality
Sperm quality also plays a critical role in conception. Generally, an average sperm count ranges between 15 million to over 200 million for every milliliter of semen. A doctor evaluates your sperm quality through a sperm analysis by examining your semen under a microscope.
If your sperm count is less than 15 million semen per milliliter or fewer than 39 million total per ejaculate, you have a low sperm count. The lower the sperm count, the less your chances of getting your partner pregnant. Additionally, other problems with sperm also play a factor in unexplained infertility.
Poor Timing of Sexual Intercourse
For a better chance at conception, most couples time their sexual intercourse with ovulation. If you’re trying to get pregnant, the right time to have sex is during ovulation. A woman is more fertile three days before and during ovulation. There’s little to no chance of getting pregnant after 12-24 hours of ovulation. This is because the egg has already left the fallopian tube making it impossible for fertilization to take place.
Luteal Phase Defect
Your luteal phase is the period between ovulation and menstruation. In this stage, the progesterone hormone promotes the growth of the endometrium in your uterus. As mentioned, the endometrial or uterine lining is where the embryo implants and grows during pregnancy.
Nevertheless, with a luteal phase defect, your body produces low levels of progesterone which hinders the growth of the endometrium. Consequently, this reduces your chances of getting pregnant because the embryo can’t implant. Fortunately, the luteal phase defect is treatable.
How Common is Unexplained Infertility?
Unexplained infertility statistics suggest that 15 to 30% of couples are diagnosed with unexplained infertility. Even so, this statistic varies. Other studies indicate that more than 10% of couples trying to get pregnant are diagnosed with unexplained infertility.
An underlying reason for the variation could be as a result of different definitions by providers of what they consider to be standard fertility testing. Some providers may include or exclude specific tests during a standard fertility assessment.
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What Tests are Included in a Standard Fertility Test?
A standard fertility test is instrumental in providing an infertility diagnosis. The assessment is done for both couples to evaluate their likelihood of conceiving. The fertility test involves:
- Pelvic examination
- Blood checks to assess the hormone levels and ovarian reserve
- Open fallopian tubes, free from obstructions
- A normal semen analysis
- Medical history evaluation that checks your menstrual cycle and ovulation.
How Do I Know If I Have Unexplained Infertility?
Since fertility is a play of many factors, only a comprehensive test can deduce whether you have unexplained infertility. A single test is not effective in ascertaining the cause of infertility.
To establish the cause, doctors perform a series of tests to get the proper diagnosis. According to the American Society of Reproductive Medicine (ASRM), the tests should include the following:
- A physical exam
- Semen analysis
- A sexual and medical history
- Ovarian reserve testing
- Ovulation cycles
- Blood tests
- Hysterosalpingogram (HSG) or laparoscopy to assess the reproductive organs.
If none of the tests are conclusive, you are likely experiencing unexplained infertility. However, don’t throw in the towel yet; a second opinion from a different medical provider could shed some light.
Can I Get Pregnant with Unexplained Infertility?
Yes, you can. Although statistics suggest that approximately 10% of couples trying to get pregnant are diagnosed with unexplained infertility, it does not mean you can’t conceive. If you are diagnosed with unexplained fertility, the probability of you conceiving without fertility treatments is lower than couples who are fertile. However, the probability is greater than zero.
If you’re below the age of 35 and you’ve been trying to conceive for a year or above it’s advisable to visit a fertility treatment center. The doctor will conduct tests to determine the underlying cause of infertility. If the tests are not conclusive, don’t worry; you can still get fertility treatment, improving your unexplained infertility success rate.
Unexplained Infertility Treatment
Like with most fertility problems, unexplained infertility is treatable. You can still retain hopes of holding your little one after a diagnosis; it’s not the end of the road. The treatments focus on what is the likely cause of unexplained infertility. Although, the treatment calls for individualized treatment. Your doctor should assess factors such as treatment history, costs, age, infertility history, and risks before putting you on an ideal treatment plan.The treatment options include:
Intrauterine Insemination for Unexplained Infertility
Intrauterine Insemination (IUI) increases the chances of fertilization by inserting washed and concentrated sperm into a woman’s uterus. The process uses a catheter to inject healthy sperm during the ovulation period. The procedure is widely adopted since it is cheaper than in vitro fertilization (IVF) and minimally invasive.
The end game with IUI is that the healthy sperm will fertilize the egg leading to pregnancy.
Clomid for Unexplained Infertility
Clomiphene citrate (Clomid) is commonly used to treat infertility in women. The medication is administered orally and works by stimulating the production of follicle-stimulating hormone. The hormone then triggers the ovary to produce more eggs-not just one. Most specialists recommend taking Clomid before referring couples to a fertility specialist.
Combining Clomid treatment with other fertility treatments, such as intrauterine insemination (IUI), increases fertility chances. Studies suggest that the monthly success rates for women over 35 using IUI and Clomid stand at 10%. Taking Clomid alone may not significantly boost your pregnancy chances. Nonetheless, combining it with an assisted reproductive technology such as IUI increases the success rate.
Some medical providers would recommend Letrozole (Femara) for unexplained fertility treatment.
Clomid vs. Letrozole for Unexplained Infertility: Which is Better?
Both Clomid and Letrozole are fertility medications that are used to treat unexplained infertility. Clomid is the most common medication prescribed by doctors for the last five decades. On the other hand, Letrozole (Femara) was previously approved for use as a breast cancer medication by the FDA. Yet, off-label prescriptions are pretty common with fertility specialists to treat ovulatory infertility.
Both medications are effective in helping women with unexplained infertility to get pregnant. However, it’s still challenging to discern which is better.
In 2015, a comparative study of both medications was done for women with unexplained infertility. The study compared the effects of both drugs in women who underwent scheduled IUI for four months. The study indicated that 35% of women who took Clomiphene had a positive pregnancy test, while the Letrozole group had 28%.
In another study conducted in 2019, 24% of patients who received Letrozole had a positive pregnancy test, while 23% of patients on Clomiphene reported the same.
Despite the conflicting results, medical specialists prefer Letrozole since it’s more effective in increasing pregnancy rates with unexplained infertility and inducing ovulation. Furthermore, it has fewer side effects.
Gonadotropins for Unexplained Infertility
Gonadotropin fertility medications contain hormones that regulate testicular and ovarian function. In females, gonadotropin injections are used to stimulate egg production. While in males, it treats low sperm count.
Studies suggest that combining injectable gonadotropins with IUI treatment or IVF leads to higher success rates for treating unexplained infertility.
Further, fusing injectable gonadotropins with timed sexual intercourse also improves your chances of conception by increasing fertility potential.
Gonadotropin injections are administered during the early stages of your menstrual cycle to stimulate multiple growths of eggs to a mature size. A doctor may also administer Human chorionic gonadotropin (hCG), which enables the release of the mature egg. A medical practitioner will monitor your egg growth through ultrasound for a higher success rate. This also helps in lessening any risks or side effects.
Timed Sexual Intercourse for Unexplained Infertility
As timid as it may sound, having timed sexual intercourse with your partner improves your chances of conception. Most people don’t know that the egg gets released from the fallopian tube 12 to 24 hours after ovulation. Coitus at this period has little to no chance of conception since the egg is already preparing for menstruation.
It is essential to time your sexual intercourse around your partner’s ovulation. The stipulated period for this is three days to ovulation or during ovulation.
In addition, tracking your menstrual cycle will hint at when to expect ovulation. You can use period apps or an ovulation kit to estimate the time. Still, for more accurate estimation, you can work out your ovulation date using your menstrual cycle. You need to know how long your menstrual cycle is.
To calculate this, you need to know the date of your first bleeding in your last period and the first day of bleeding in your next. For instance, say your last period started on the 1st of January, and you expect your next period to begin on the 26th of January. Subtracting the two dates gives you a menstrual cycle of 25 days. To get your approximate ovulation date, you need to remove 14 days which gives you 14. This means you should expect your ovulation date to be around or on the 14th. To be on the safer side, it is advisable to have regular sexual intercourse three days before the date and on the date.
Lifestyle Changes for Unexplained Infertility
According to statistics, 30% of women with weight extremes experience infertility, which is three times higher in obese women. This is because insulin resistance in the body impedes ovulation. Losing as little as 5% of body weight can help you improve your fertility.
Lifestyle changes are integral to increasing your chances of conception. This applies to men, too, since obesity in men affects the production of testosterone and other hormones that promote sperm count, mobility, and quality.
A healthy diet and frequent exercise are important for improving your weight and fertility. As well, lifestyle changes, such as avoiding caffeine, smoking, and alcohol, significantly promote your reproductive health. A study by Harvard showed that women reduce their risk of unexplained infertility from ovulation disorders by 80 % by adhering to a healthy diet.
Assisted Reproductive Technologies for Unexplained Infertility
Assisted Reproductive Technologies (ART) refers to a procedure where the embryo or eggs are managed as part of fertility treatment. The process involves the surgical removal of a woman’s eggs and combining them with sperm in the lab. The fertilized egg is then reintroduced into the woman’s body.
ART remarkably helps increase the chances of conception with a rate per cycle of 50% for in vitro fertilization (IVF). IVF is the most common ART procedure that helps curtail the effects of unexplained infertility. The first ever successful IVF procedure was performed in 1978. The procedure has since then developed, making its access much easier. Some doctors will perform an IVF with intracytoplasmic sperm injection (ICSI) to better your chances of conception.
Unexplained Infertility Success Stories
Now that you know a tad more about unexplained infertility, here are real-life examples of people diagnosed with unexplained infertility and later got pregnant. However, you shouldn’t treat this as medical advice. Every individual has a different experience. The success story is to inspire you that your TTC journey is possible with an unexplained infertility diagnosis.
Success Story 1: Joyce: A silver lining after all hopes were lost
Age:37
The story of Joyce is interesting and inspirational too. Joyce visited the fertility cloud, having been diagnosed with unexplained infertility. She had an AMH test which showed her ovarian reserve was normal, with a level of 3.69 ng/ml AMH. Also, a hysterosalpingogram test showed her fallopian tubes were not obstructed. Joyce went further to have her partner examined, as is the case with unexplained infertility. Her partner had a normal sperm count, if not healthy swimmers. Furthermore, her partner also sired three children in his previous relationship, which ruled out any case of infertility.
Joyce explained that they’ve been trying to conceive for the past 15 months without a positive outcome. Prior to consulting us, she had received Clomid treatments combined with an IVF. But, this did not work.
After a thorough evaluation, we realized that Joyce is experiencing a luteal phase defect. Meaning her uterine lining did not develop to allow the embryo to implant. We administered a few more tests, including ovarian stimulation and progesterone support, and a treatment cycle and later; she got pregnant.
Joyce is one of the many patients who can attest that unexplained infertility is not a death sentence. Although many couples lose hope after a series of tests and unsuccessful fertility treatments, Joyce is a testimony that there is always a silver lining.
Success Story 2: Racheal: A beacon of hope
Age:38
Elizabeth got married to her life-long partner at the age of 34. A year later, they embarked on their TTC journey, which proved unsuccessful after a few trials. She then sought the help of a gynecologist who did an HSG test. The test showed that her fallopian tubes were open. An Anti-Mullerian Hormone test (AMH) also showed her ovarian reserve was good. Furthermore, her menstrual cycle and ovulation were on time, aside from some mild spotting she’d experience every mid-month. It’s worth noting that during this time, her partner did not undergo a sperm analysis test.
After being diagnosed with unexplained infertility, Elizabeth paid us a visit with much despair on her face. We took her through the standard fertility tests to ascertain the underlying cause. At first, we couldn’t discern the problem and then performed a sperm count analysis that showed the husband’s sperms were in plenty and of good quality.
We advised Elizabeth to take a 50 mg dosage of Clomid two days before her menstrual cycle ended. We also encourage the couple to have timed sexual intercourse to increase their chances of conception. A few months later, Elizabeth returns to our offices with a pregnant stick and a pregnancy glow. Her exact words were, “I AM FINALLY PREGNANT.”
Elizabeth delivered her baby in August 2021, and her baby is healthier than ever.
FAQ
What Helps Unexplained Infertility?
There are many ways of going about unexplained infertility. If a doctor cannot discern the reason behind your unexplained infertility, it helps to get the opinion from a different medical practitioner. It could be the doctors missed out on a test, or a faulty test result contributes to your inconclusive fertility results. Anyhow, this shouldn’t despair you. Treatment options such as fertility medication, in vitro fertilization, intrauterine insemination, and lifestyle change significantly increase your chances of conception.
Does Unexplained Infertility Occur in Both Males and Females?
Infertility is a play of various factors, making it challenging to pinpoint the primary cause behind it. However, fertilization is only possible using the male’s sperm and the female’s eggs. This means unexplained infertility is a beam balance that holds the couple on both sides. If the couple undergoes fertility testing and there’s no apparent cause for infertility, the couple is likely experiencing multifactorial infertility.
Male factor infertility is the sole cause of infertility in approximately 30% of couples who undergo fertility testing. Further, it acts as a contributing factor in 20% to 30% of couples.
In such cases, it is prudent for both partners to undergo a thorough fertility testing evaluation. The evaluation could reveal further evidence of infertility or factors inhibiting your conception, such as obesity. As mentioned, obese males experience a low sperm count due to low progesterone levels. Furthermore, the evaluation also outlines whether you have issues with your reproductive organs, such as the fallopian tubes or uterus.
In males, the evaluation covers their history, semen analysis, and body evaluations. Crucial factors that can also help underpin infertility causes include a history of cryptorchidism, sexual dysfunction, medical and surgical history, tobacco or alcohol use, and prior paternity.
I Have Been Diagnosed with Unexplained Infertility. What Next?
An unexplained infertility diagnosis should not dwindle your hopes of getting pregnant. There are more approaches you can take to improve your chances. For starters, you need to examine your lifestyle habits and assess whether they contribute to a healthy outcome. It is prudent to avoid alcohol, caffeine, and smoking. Smoking can deter production of hormones, making it hard to conceive. Additionally, smoking can result to a damaged DNA in the sperm.
Also, switching to a healthy diet and frequent exercises helps keep your body healthy and ready for pregnancy. We understand making such lifestyle changes is not easy. Rome wasn’t built in a day, either. Setting personal goals and starting small eventually leads to long-lasting results. It also helps if you rope in your partner and embrace a healthy lifestyle together.
Over and above that, timed intercourse can significantly improve your chances. Every year, you get 12 opportunities to get pregnant. This is your ovulation period. It is imperative to have regular intercourse during and around this time for better chances at conception.
What is Unexplained Secondary Fertility?
Unexplained secondary fertility occurs when you have trouble getting pregnant after having a first successful pregnancy. After having your first baby, it’s common to want to go through the joyous process of pregnancy. However, in some cases, some women experience infertility issues when trying to get pregnant for a subsequent time. A visit to the OBGYN may reveal the problem. However, in cases where you receive inconclusive results, you are likely experiencing unexplained secondary infertility.
Unexplained secondary fertility works in the same principle as primary unexplained infertility. What’s more, it also shares the same symptoms. Unexplained secondary infertility can be caused by:
- Issues with the uterus, such as fibroids of adenomyosis
- Problems with ovulation
- Damage to the fallopian tube during fertilization
- Poor count and quality of sperm
- Scarring from endometriosis
- Complications from previous pregnancy or surgery
- Age
- Use of certain medications.
Unexplained secondary infertility can be stressful. Though, you can get the right help by visiting a doctor and starting fertility treatments. If you’ve been trying to get pregnant for a year and you’re younger than 35, it is advisable to seek medical counsel on fertility. Likewise, if you’re above 35 and you’ve been trying for six months, you need to talk to a doctor.
Is Unexplained Secondary Infertility Common?
Unexplained secondary infertility is as common as unexplained primary infertility. About 12.5% of couples who are trying to conceive experience infertility. Out of this statistic, approximately 50% of the couples are experiencing unexplained secondary infertility.
Does Acupuncture Help with Unexplained Infertility?
Acupuncture is a therapy that involves piercing your skin with thin needles at specific locations on your body. The practice is an ancient Chinese tradition believed to cure pain. Today, they use it for wellness therapy and alleviating stress.
Various studies have looked into the possibility of acupuncture curing unexplained infertility. The studies used two cohorts of women. One group had women diagnosed with unexplained infertility, and a control group of women. Both groups had been trying to conceive for five years.
The acupuncture procedure was administered to the first group in 3 menstrual cycles. In addition, they also received prescribed fertility treatments. The second group received controlled ovarian hyperstimulation treatment.
After a few cycles, the women in the acupuncture group conceived naturally without undergoing COH. The study proves that acupuncture can significantly improve unexplained infertility by reducing the number of COH cycles. Hence acupuncture alone is not enough to help with unexplained fertility, but combining it with other fertility treatments improves your chances of natural conception.
Can Myo-Inositol Help with Unexplained Pregnancy?
Extensive research into infertility and women led to the discovery of myo-inositol as a fertility medication. Myo-Inositol promotes regular ovulation and regulates hormones for women diagnosed with PCOS.
A study published in the Human Reproduction journal showed that follicular fluid with high levels of Myo-inositol led to enhanced egg maturation and quality. Moreover, a study published in the International Journal of Endocrinology showed a better success rate of medical fertility after combining melatonin and Myo-inositol. Furthermore, the medication has a long track record of effectiveness and safety.
If you’re diagnosed with unexplained infertility and struggling to conceive, speak to your doctor about the perks and risks of using Myo-inositol.
Final Thoughts
So you’ve been diagnosed with unexplained infertility. It’s not the end of the road, It is the beginning of a new journey in your pregnancy. Studies so far show positive unexplained infertility success rates with the proper fertility treatments.
If you’re having trouble conceiving, it’s prudent to seek medical counsel. The sooner you do it, the better. All the best!