How Is Unexplained Infertility Diagnosed and How Is It Treated?

With all the advancements made in technology and the field of medical science, unexplained infertility is still a mystery. More importantly, this infertility is more common than you would think. There are many couples who are unable to conceive a child, yet the reason for their infertility is not determined. With all the diagnosis and tests available these days, there are still some cases of infertility which don’t have any specific reason.

Dr Uday (Indira IVF hospital), explained “Infertility itself is a common occurrence these days, particularly among older couples. On a rough estimate, around 50% of cases are caused by fertility issues in the female, with 40% being caused due to male fertility issues. It can happen that the infertility is caused due to issues with both the partner. For the rest 10% of cases, the doctors don’t have any explanation. Couples with this sort of infertility have a hard time dealing with it since they don’t know the cause of it”.

Infertility diagnosis

It is actually surprising that the number of cases where fertility cannot be explained is quite high. With these cases, there is no physical or medical reason at all due to which the couple is possibly failing to conceive. The fact that there is no definite reason should be alarming for infertile couples. It makes it important for them to try and understand the condition better.

Of course, not every case of infertility is unexplained. A male or a female can be diagnosed as infertile only after some specific examinations and routine tests are carried out. However, in certain situations, the reports are completely normal. When there is no medical evidence supporting the cause of the issue, the case actually remains unexplained.

Dr. Puja Rani (Gynaecologist & IVF Specialist, Indira IVF, Ranchi), revealed “Unexplained infertility diagnosis is not easy to establish. Fertility doctors will diagnose your infertility as unexplained only after performing a series of checks on both the concerned partners. Doctors reach this conclusion only if they believe that a cause for infertility cannot be established after analyzing all the test results”. They believe that the problem is probably being caused by certain risk factors such as stress, weight issues, environmental toxins, alcohol, drug usage, smoking, caffeine consumption, excessive exercising, etc.

All of these are just the theoretical factors that are known to affect fertility. If nothing else explains your infertility, you should try eliminating these risk factors first. While these factors aren’t necessarily the cause of the diagnosis, limiting them can actually help you in conceiving.

How are all probable causes of infertility eliminated?

When a couple cannot conceive, they often search around hopelessly looking for answers. In most cases, certain physiological defects in either or both the partners cause infertility. These cases are easy to diagnose and the doctors prescribe a treatment depending on the cause of infertility. However, as is the scenario with other cases, doctors find it difficult to point out the reason why the couple is unable to conceive. This type of infertility is also known as idiopathic infertility.

Dr. Nitisha Lath (Gynaecologist & IVF Specialist, Indira IVF, Ranchi), explained, “For diagnosis of any infertility, certain standard tests and procedure are carried out. These tests eliminate all common causes that are known. For instance, laparoscopic surgery may be performed to check for infertility in women. This is done for investigating the pelvic cavity of the woman. Even tests like these might not be enough for the diagnosis. Nowadays, it is even harder with the increasing number of cases of infertility with unexplained causes”.

Among married couples, the occurrence of this condition is more common when the female partner is above 40 years of age. It can also happen when the concerned woman is below 35 years of age, although they are comparatively fewer in number. Hence, it is quite clear that this form of infertility, just like any other infertility, is more common among older women. The unexplained infertility treatment your doctor recommends will also depend on your age.

Through the standard tests, some of the obvious causes of infertility that are diagnosed include low or abnormal sperm count, blocked fallopian tube and ovulation problems. However, there are no tests done for finding molecular problems.

Chances of infertility increase significantly beyond the age of 35. There are obvious reasons behind this. As a woman grows older, she is more likely to have troubles with ovulation. The quantity and quality of eggs released from the ovary are affected because of this. There are hormonal changes as well, which are known to contribute to fertility issues.

Tests carried out after infertility is diagnosed with unexplained causes

Dr Puja Rani (Chief Infertility & IVF Specialist, Indira IVF, Ranchi), explained “Once the diagnosis for infertility is completed, the doctors recommend further tests and procedure based on the diagnosis. If they find a reason behind infertility, they will recommend treatment options to eliminate the causes. They may also carry out further tests based on the initial diagnosis”.

However, when the infertility is diagnosed with an unknown cause, the concerned couple has to undergo three different tests. There are good chances that these tests would actually provide you a hint about your condition.

• Firstly, the medical history of both partners is reviewed. Sometimes, checking the medical history can help determine if there is any disease that could possibly result in infertility
• The male partner needs to have his semen analyzed. The semen analysis checks whether the male in concern has a normal sperm count necessary for reproduction or not. The quality of sperm is also checked.
• Hysterosalpingogram can also be performed to identify any blockage of fallopian tubes

If you are lucky, these tests will give an indication of a probable cause of your infertility. It is better to undergo thorough testing and tick off all the boxes before coming to a conclusion.

Causes of unexplained infertility

Couples suffering from infertility with unexplained diagnosis should know that there are various reasons behind the condition. They should have an idea about all the probable causes of infertility so that they can get the right treatment. Some possible unexplained infertility causes include:

• Abnormalities in the fallopian tube: During a normal reproduction process, it is the fimbria in females that picks up the eggs from the ovary after ovulation. It may happen that the mechanism that results in picking up eggs is defective. Even improper functioning of the cilia of the tube can be a cause.
• Psychological issues: There are studies that indicate that emotional disturbance with a person can also affect his/her hormonal cycle. The hormones are directly linked with the brain. Hormonal problems are also known to cause fertility issues.
• Sperm’s inability to penetrate eggs: It may happen that the male partner’s sperm count is normal and there is no problem with it. Yet, it is possible that the sperms are unable to penetrate the eggs. It can be checked through the IVF process. Donor sperm can be used and if it fertilizes the egg, it confirms that the sperm of the male partner is unable to penetrate the eggs.
• Abnormalities during luteal phase: During the female reproductive cycle, the luteal phase is the one where eggs are released. If there is any abnormality during this phase, the female may find it difficult to get pregnant. It is the corpus luteum that is responsible for the production of progesterone hormone in females. This hormone prepares the endometrium wall to receive the fertilized eggs. If adequate amounts of progesterone are not produced or if the endometrium doesn’t respond to the hormone, it can cause infertility.
• Abnormal eggs: This is one of the causes that can be diagnosed or even treated during unexplained infertility IVF. Sometimes, the eggs are produced naturally and released but have abnormal structures or a chromosomal anomaly. This can be determined through preimplantation genetic testing on the embryo. Chromosomal abnormalities can be eliminated through this procedure.
• Immune system: Immunological factors can also contribute to infertility. In men, the immune system can react with the sperm and even destroy or kill them. The sperm may not be motile enough. In women, there is a possibility of immune reaction in the coating of the eggs, which prevents the sperm’s entry into it.
• Trapped eggs: There are a few cases where the eggs are produced normally and in a healthy manner, although the corpus luteum is unbroken, causing the eggs to be trapped inside it.
• Infections: There are certain infections which can actually be a cause of infertility. If you are suffering from mycoplasma or Chlamydia infections, you should get treatment for it. It may be standing in the way of your fertility.
• Endometrium problems: Women having defects in the uterine line, also known as endometrium wall, are likely to be infertile. This is because issues with the endometrium wall prevent the embryo from implanting onto it. This is a relatively common cause and doctors should check for it. There are a number of methods that can be used for checking it, including ultrasound scans through vagina. It allows the doctors to determine the endometrium’s thickness. It may happen that the endometrium wall is thin because of inadequate flow of blood to it.

Unexplained Infertility Treatment

Dr Mekhla Goyal, (Gynaecologist & IVF Specialist, Indira IVF, Ahmedabad), explained “If you are diagnosed to be infertile and there are no medical or physical causes behind it, there is no need to lose hope. It is indeed possible to resolve the issue and get pregnant with unexplained infertility”.

Sometimes, there isn’t even any need for infertility treatment. With infertility, the time period plays an important role. The chances for the woman to conceive get lower with longer duration of infertility. If the causes are not known, you can continue to try to conceive with your partner. There are chances that you will get pregnant within 3 years of trying. If you have been trying for over 5-6 years, the probability of conceiving naturally is reduced to 10%.

After a certain period of time, it is wise to consider infertility treatment options. Some infertility treatments you can consider include ovarian stimulation through fertility drugs, Clomid plus insemination, injectable gonadotropins, etc. Of course, you also have assisted reproductive technologies available. IVF is one of the most common technologies used. In fact, it is often the preferred Unexplained Infertility treatment option for infertility with unexplained causes. So, all hopes are not lost. You definitely have other options to consider.