You are infertile but the cause is unknown

Dr. Abayomi Ajayi When it takes longer than normal for a couple to achieve pregnancy, various questions usually come to mind about what th...

Dr. Abayomi Ajayi When it takes longer than normal for a couple to achieve pregnancy, various questions usually come to mind about what the problem could be. About one in five couples seen by the fertility specialist are diagnosed with unexplained infertility meaning no reason was found for their not getting pregnant. There are many probable causes of infertility but unexplained infertility, which is also known as idiopathic infertility, can best be described as infertility in which the standard testing has not found a cause for the failure to get pregnant. It means neither the man nor the woman has any major, obvious reasons for infertility; However, people diagnosed with unexplained infertility may have other, more subtle issues that the current diagnostic testing can’t detect, such as poor egg quality. A couple is normally given a diagnosis of unexplained infertility when no cause can be attributed for failure to achieve conception. In strict terms, unexplained infertility is essentially a negative diagnosis. The point is this: there is a problem but the cause is unknown. Unexplained infertility is quite common even with availability of several fertility diagnostic approaches. Discovering the reason behind the cause of any form of infertility is crucial. The logical question is if it’s not the man and it’s not the woman, then what is the cause? There has to be a cause and a way to overcome the problem. When coping with unexplained infertility, it is advisable to take an active role in working with a qualified fertility expert along with other health providers to uncover the root causes. Commitment, dedication and hope are essential, but seeking the right assistance at the right time is just as crucial. The first step is to understand what unexplained infertility is about. Not all the causes of infertility are usually discovered and this is responsible for more couples being classified in the unexplained category. The current rate of unexplained infertility is about 50 per cent for couples with a female partner under age 35, and about 80 per cent by age 40. Normally, several processes need to occur in the right order and at the right time before a woman can get pregnant and have a baby. There are several events that have to happen perfectly in order to have a pregnancy develop. Standard tests for infertility are really only looking for obvious factors, from blocked tubes, abnormal sperm counts, ovulation problems, etc. Generally, Assisted Reproductive Technology (ART) has revolutionised the treatment of most common types of male and female infertility. The most commonly utilised form of ART currently available is In vitro Fertilization (IVF) which involves retrieving mature eggs from the woman, fertilising them with sperm in a dish in a laboratory and replacing the embryos in the uterus two to six days after fertilisation is confirmed. As a medical advance, IVF has given numerous childless couples opportunity to have their own biological children. Many couples may not want to be told that they should “keep trying on their own” for few more months. However, in some cases, it may be a good plan, but this would be only after testing has confirmed diagnosis as unexplained. Such couple may continue to try on their own (if willing) for six months to a year, utilising fertility drugs and some of the more invasive procedures. Typically, when a couple cannot get pregnant, the first step is fertility testing, then, once a cause (or causes) is found, appropriate treatment is pursued. If a woman is not ovulating, an ovulation drug may help. If it is sperm counts that are low, Intrauterine Insemination (IUI) or IVF /ICSI may be recommended. Unexplained infertility is treated according to a process, based on clinical experience. A full diagnostic process is usually undertaken, from researching family medical history to physical examinations to hormone tests. The most common treatment map involves lifestyle changes like weight loss, quitting smoking and healthy diet. When looking at all infertility causes and cases, live birth rates after treatment are just under 50 per cent so making the right choice is critical. Usually, a fertility expert is to be consulted first when trying to treat any form of infertility. This expert is most likely to prescribe a fertility drug even if unexplained infertility is the diagnosis. For couples with unexplained infertility, IVF has the best odds for pregnancy success. The pregnancy rates for IVF treatment are three times what they are for Intrauterine Insemination (IUI)depending on age; Not only are the success rates higher for IVF, the cause of the “unexplained” infertility is sometimes discovered during treatment. Only during IVF can egg quality, the fertilisation process, and embryo development be observed closely. IVF and IUI are common therapeutic mainstays for couples with unexplained infertility. The former involves inserting sperm directly into the uterus, while the latter works by uniting the sperm and the egg cells in a laboratory dish. IVF has a higher success rate. However, some patients continue to struggle and suffer the associated financial burden of repeated cycles. Repeated failed rounds of IVF can help identify causes of infertility. For example, if sperm and egg quality are normal, then the conception issue may be rooted at the embryonic or implantation level. In other words, if IVF fails to result in pregnancy despite successful fertilization, embryonic development or implantation may be to blame. Proceeding straight to IVF and skipping IUI may be the best choice if the woman is aged 38 or older. While many cases of infertility remain unexplained, there may be answers in the genetic makeup of the couple. Fertility in many cases is a state which changes throughout life. The road to pregnancy can be long and rough, therefore couples need to educate themselves on the latest interventions and ask the right questions, particularly those that tend to address common themes such as seeking second opinions, repeating tests, and exploring alternative testing to get more in-depth data that can inform treatment. Patients should ask their clinician about the prospect of repeating some tests such as semen analysis. If these tests remain unremarkable, patients should inquire about the following less common conditions and tests. It is possible that a significant contributor to unexplained infertility can be attributed to changes in sperm parameters. Often these subtle infertility factors of unexplained infertility can be seen during IVF, so IVF can also be diagnostic. Even women with excellent ovarian reserve can have poor egg quality seen under the microscope at the time of egg retrieval. Couples with mature eggs and normal semen parameters may have poor fertilization, which can only be seen during IVF. Sometimes embryo development is the issue. Sometimes it’s an implantation issue. These are the diagnostic benefits of IVF that cannot be detected in any other way. In addition, once identified there are many options for treating and overcoming these infertility factors with IVF. When the cause of infertility is unknown, improvement of overall health is important. Commonly suggested lifestyle changes include weight loss if overweight, exercise, smoking cessation, reduced alcohol consumption, caffeinated drinks and stress. Given the shot-in-the-dark or trial and error approach to unexplained infertility treatment, lifestyle changes to improve your overall health may help.