Unexplained Infertility: Explained

The diagnosis of “unexplained infertility” is one of the most infuriating things a couple can be told by their fertility specialist. This “diagnosis” comes after multiple appointments for testing and, all too often, repeat infertility cycle failures.

There are a few things we want you to know if you’ve been told you have unexplained infertility (UI):

  1. You are not alone. RESOLVE states that upwards of one in five couples (and some experts say it’s one-in-four or 25%) will be told they have UI. If you haven’t already, find an online support group and start chatting; your UI sisters and brothers will be there for you.
  2. There is hope. A notable number of couples with UI (40%+) wind up conceiving – some without ART and some with more expert fertility specialist support.
  3. Finding an experienced and thorough fertility specialist is essential. Some HMOs are notorious for not referring patients to fertility specialists. Furthermore, some fertility specialists simply aren’t willing to go the extra mile because they prioritize quicker “diagnosis” for more successful IVF rates, leaving UI couples without thorough testing and investigation.

If you are struggling with an unexplained infertility diagnosis, schedule a consultation with us here at the Northern California Fertility Medical Center.

We go far beyond “standard” in our initial fertility workups, and we are 100% dedicated to finding out exactly why you aren’t conceiving or carrying full-term deliveries.

Explaining “The Diagnosis That Isn’t”

Truthfully, unexplained diagnosis is not really a diagnosis at all. It is more of a medical statement that says, “We see that you ovulate fine, your tubes are open and that the sperm seem perfectly healthy. Unfortunately, we are not really sure why you can’t get pregnant and carry a full-term baby.”

In order to be labeled with Unexplained infertility, at a minimum, 3 factors need to be examined:

  1. Eggs: Regular cyclic ovulation. If your periods come like clockwork, you can check off that factor (although age does play an important factor).
  2. Sperm: A normal semen analysis.
  3. Tubes: A normal hysterosalpingogram (HSG).

Take Action After an Unexplained Infertility Diagnosis

There are three things to do in order to take control of your fertility future after an unexplained infertility diagnosis.

1. Find a fertility specialist with a successful UI track record

As we mentioned above, HMOs are notorious for not referring people to outside fertility specialists, and their in-house physicians are not always dedicated to digging deep into trickier infertility cases. Finding the best fertility specialist in your area is key to peeling back the “standard infertility diagnosis” layers and getting closer to the heart of the matter.

2. Make sure your tests were complete (and not just the top-layer rungs)

Not all fertility testing protocols are created equal. For example, every couple pursuing infertility testing should have had tests that verified:

  • An absence of common infertility factors such as endometriosis or PCOS
  • Regular ovulation cycles
  • Healthy ovarian reserves
  • Healthy sperm count, shape, and movement
  • There are no uterine or tube abnormalities blocking conception, implantation, or healthy fetal development

If those bullet points have been confirmed, and everything appears healthy – you officially have a case of unexplained Infertility. However, those are just the basics.

Now, there is more testing and evaluation to be done, but not all physicians and specialists suggest it. Often, they’ll continue putting you through fertility treatment channels, putting you at risk for repeat failure and heartbreak because they can’t match the treatment to the “unexplained” issue, not to mention wasted resources that should be conserved until you have a more concrete diagnosis.

3. Make sure your fertility specialist is going the extra diagnostic mile

Don’t be shy about asking for more support and analysis from your fertility specialist. Has s/he looked into the following:

An in-depth physical. Underlying medical conditions, particularly those that create an autoimmune and/or hyperinflammatory response can stymie reproduction. Examples include celiac disease, insulin resistance, lupus, rheumatoid arthritis, etc.

Genetic screening. Have you had preconception genetic screening? Testing is the only way to determine if you are a carrier for a chromosomal or genetic abnormality. If you are, you may never conceive or carry a baby full-term (or you may opt not to  prevent passing it on). You deserve to know so you can make educated choices.

Poor egg or embryo. Unfortunately, we do not have a clear way to test for poor egg quality…yet. To date, preimplantation genetic testing (PGT) is the best way to detect if poor egg quality or poor embryo quality is a factor. For some patients, 100% of the embryos were genetically/chromosomally compromised. Now they can feel confident moving on to egg or embryo donation options. For others, many them were abnormal, allowing us to exclusively transfer healthy embryos for more successful IVF outcomes.

Testing miscarriage material. If you have a history of recurrent miscarriages, or you miscarry after a successful fertility treatment, we highly recommend saving as much of the miscarriage tissue as you can. We completely understand that at that point, you are in the midst of a heartbreaking scenario. However, testing the tissue can tell us so much more about potential infertility issues, paving the way to more customized treatment options.

Read our post, After a Miscarriage: The Testing to learn more.

The potential for mild endometriosis. Some women aren’t aware they have mild endometriosis, and this can lead to endometrial tissue that blocks, scars, or irritates reproductive parts. Laparoscopy may be necessary to diagnose and correct it. We may also use RecepivaDx testing.

Other “Explanations” for UI. (1) Cervical Factor: Some couples have a cervical issue where either hostile cervical mucous attacks sperm or guys have sperm that have a hard time passing through any cervix. Although there really is no good test for this, intrauterine insemination (IUI) is a relatively easy fix. (2) Sperm-Egg Interaction: Sometimes the shell of a woman’s egg is hard enough to block sperm or the sperm is missing an enzyme that prevents penetration of all egg shells. Similarly, there is no good test for this but Intracytoplasmic Sperm Injection (ICSI) is the solution.

If you have an unexplained infertility diagnosis, be an advocate for yourself and begin collaborating with an experienced, curious, and dedicated fertility specialist who will accompany you in finding clear answers. Contact NCFMC to schedule a UI consultation.

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