What do you think about unexplained infertility?

Dealing with Unknown Virtue or a demerit

Significant number of couples (one out of six) are struggling to have pregnancy. Majority of them have reason for their infertility.But 10-15% of them do not know their cause of infertility.They belong to a group called “Unexplained infertility /idiopathic infertility .

Here the reason for not getting pregnancy is not known in spite of thorough evaluation of the couple.
Since finding solution to a known problem is easy, dealing with unknown and uncertain can be stressful at a times frustrating to both the infertile couple and the treating doctor.

But to the paradox,treatment options can be many .We can opt an empiric and a stepwise approach as we don’t have any specific hurdle.

Do you really belong to unexplained infertility group?

A couple is said to be infertile when they are unable to have child even after 1 year of regular unprotected intercourse .Six months if age of female partner is 35 years n above
.
Infertility is just an expression of underlying abnormalities in reproductive or systemic component of either male or female partner or both.Whenever a couple visits a fertility centre they are subjected to battery of tests to find these underlying abnormalities.These tests includes husbands semen analysis ,wife’s ovulation study, hormonal profile ,pelvic ultrasound ,and tubal patency test. When no apparent reason is detected and all of the above test are normal couple is labelled as Unexplained infertility .

Time to dig out the clues for these hidden causes of infertility

Though no noticeable cause is identified on routine investigations, subtle or occult defects in basic things which form the pregnancy can be suspected.

There can be problem with sperm function , egg quality ,sperm and egg interaction ( fertilisation),functional defect in Fallopian tube lining leading to transportation defect ,subtle anatomical abnormalities,disturbed tubo-ovarion relationship ,immunological alteration in womb causing implantation failure ( embryo uterus cross talk),early Endometriosis and Luteal phase defect.

Routine tests are unable to detect these issues

Recently life style related issues like faulty food habits ,obesity ,alcohol ,smoking ,disturbed sleep pattern ,certain psychological conditions ,toxins and environmental pollutants have shown to affect fertility potential of couple.

So its an orchestra of multiple factors which can either play together or if not in order can disrupt the whole rhythm of fertilizing process and pregnancy.

• Advanced evaluation and smart approach can nab the culprit –
Tests like sperm function evaluation ,sperm DNA fragmentation index ,assessment of endometrial receptivity,immunological tests and in rare cases diagnostic hysteroscopy- laparoscopy can be helpful in identifying cause.

• Unexplained infertility doesn’t mean Inconceivable —
Without apparent cause it’s difficult to formulate exact treatment plan for unexplained infertility.
But uncertainty also opens many possibilities.
So definitely there is reason for Hope, only limiting factor would be preparedness from the couple , treating doctor and patience.

The key to conundrum

1. Simply wait (Expectant management):Since most of the times couple is unaware about fertile period with infrequent intercourse ,knowledge of fertile period with timed intercourse for at least 3 months may work especially with young couple.This fecundity is about 20% but that is reduced in unexplained infertility.

2. Ovulation induction coupled with IUI:
If age of female partner is more than 35 years or if martial length is more than 3 years its always better to intervene early.This milder form of intervention is ovulation induction with drugs like clomiphene citrate or letrozole followed by intrauterine insemination (IUI) .This increases the chances of fertilisation with availability of more eggs, concentrated washed motile sperms and confirmed ovulation.This regimen has good chances of pregnancy about 15-20% in one cycle.

3. In-vitro fertilisation— IVF is very much rewarding in such cases .Other than its therapeutic benefits ,it also throws lights on diagnostic aspects and unravels the hidden causes of unexplained infertility because it deals with the very basic ingredients of pregnancy i.e sperm ,egg ,sperm- egg interaction, and culture of embryos.

It offers higher pregnancy rates in unexplained infertility since it gives chance to select healthy sperms ,healthy eggs ,and healthy embryos ultimately giving a healthy pregnancy.
Technological advances like sperm washing , sperm selection, embryo culture ,Blastocyst ,Assisted Hatching ,PGD are boon for infertile couples longing for he
healthy baby .But technology comes at cost.

4. Lifestyle modifications like physical activity ,healthy diet habits, reduction in alcohol intake, stopping smoking and stress management definitely supplements any of above treatments improving live birth rate.

In the end ,I would say that unexplained infertility though it comes wit lot of uncertainties and unanswered questions but it has good prognosis in present scenario with modern treatment options and stepwise approach.

Remember no news means good news. (every dark cloud has a silver lining)