Unexplained Infertility
Unexplained Infertility is a diagnosis of exclusion. When standard investigations of both the female and male partner have ruled out other infertility diagnoses, Unexplained Infertility is what remains. It doesn't mean that there is no reason for the infertility, but that the reason is unable to be identified at that time. Approximately 10 to 15 percent of couples will receive the diagnosis of unexplained infertility.
The conventional infertility evaluation in the female may include: medical history, physical examination, tests of blood hormone levels, ovulatory function, and hysterosalpingogram (HSG) (an x-ray of uterus and fallopian tubes). Laparoscopy, which involves the insertion of a thin, lighted telescope-like instrument into the abdomen to look at the uterus, ovaries, and fallopian tubes, may be necessary to exclude factors such as endometriosis and adhesions (scar tissue) which may not be apparent by HSG. The conventional infertility evaluation in the male may include: medical history, physical examination, semen analysis, and hormonal testing.
Of course, the Unexplained Infertility diagnosis is totally dependent on how extensive a diagnostic work-up has been performed: the more limited the work-up, the more frequent the diagnosis of unexplained infertility will arise. Many cases of unexplained infertility are nothing else but undiagnosed cases of endometriosis and immunological infertility. Our physicians always perform exhaustive diagnostic work-ups before reaching the diagnosis of unexplained infertility. However, once such a diagnosis is reached, our physicians are experts in offering up the appropriate empiric treatments.
There is no consensus as to the optimal therapy for the treatment of unexplained infertility, since many couples with one to three years of unexplained infertility will conceive spontaneously. In the female, empiric treatment (infertility treatments when no known cause of infertility has been diagnosed) with ovulation induction drugs for three to six cycles combined with intrauterine insemination (IUI) (inserting prepared semen directly into the uterus), followed by IVF or gamete intrafallopian fertilization (GIFT), is an approach frequently used. GIFT is an assisted reproductive technique that involves injecting a mixture of eggs and sperm directly into the fallopian tube.
When unexplained infertility is diagnosed, treatment options include no intervention, intrauterine insemination, empiric clomiphene cycles with or without insemination, superovulation with insemination using gonadotropins, GIFT and IVF. Evaluation of each individual situation will help determine the most advisable course of action.
Recent research indicates that pregnancy rates with these therapies are equal to or higher than pregnancy rates of couples with other infertility diagnoses. In the future, increased understanding of human reproductive physiology will allow more effective therapies for patients with unexplained infertility.
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