Unexplained Infertility

Unexplained infertility overview

  • When infertile couples or individuals have undergone all appropriate tests and no cause for their infertility is found, they are diagnosed with unexplained infertility.
  • About 15 percent of infertile couples are diagnosed with unexplained infertility, also referred to as idiopathic infertility.
  • Unexplained infertility most likely involves issues with poor egg or sperm quality, or problems with the uterus or fallopian tubes that aren’t identifiable during normal fertility testing.
  • Likely treatments for unexplained infertility that are often successful include:
  • Fertility drugs with intrauterine insemination (IUI)
  • In vitro fertilization (IVF)
  • Ovarian stimulation
  • Timed intercourse
  • Lifestyle changes.

What is unexplained infertility?

Unexplained infertility is when standard infertility testing has not found a cause for a couple’s or a woman’s inability to get pregnant. Some reproductive physicians hold that a diagnosis of unexplained infertility is a non-diagnosis.

Estimates indicate that anywhere from 15-30 percent of couples experiencing infertility are diagnosed as having unexplained infertility. This makes it one of the greatest causes of infertility.

The variation in estimated percentage of unexplained infertility is due to the fact that experts do not agree on what should constitute “standard infertility testing.” Testing can vary according to the individual’s situation and their physician’s testing protocols.

The American Society for Reproductive Medicine’s guidelines for standard infertility testing call for:

  • Ovulation assessment
  • Hysterosalpingogram (HSG) that evaluates the condition of the uterus and fallopian tubes
  • Semen analysis
  • Ovarian reserve evaluation
  • In some cases, diagnostic laparoscopy, a minimally invasive surgical technique that allows a physician to view internal organs and conditions via a tiny camera

These may be performed in addition to a physical exam and review of medical and sexual history.

Both partners may have unexplained fertility problems. Unexplained infertility can be frustrating because affected people know they have a problem but not what is causing it. As with some conditions causing infertility, unexplained infertility may correct itself over time.

Causes of unexplained infertility

By definition, the causes of unexplained infertility are unknown. It’s possible that a person or couple who are fertile may be diagnosed as having unexplained infertility because they have not been successful in reproduction after one year.

Similarly, some fertility physicians think that a likely cause of unexplained infertility is that the tests performed to assess infertility in the first place may have missed subtle defects due to imperfect testing methods.

The more likely causes of unexplained infertility involve:

  • Ovulation problems
  • Poor egg quality
  • Poor sperm quality
  • Insufficient frequency of sexual intercourse or intercourse not timed to coincide with ovulation – learn more about how to get pregnant
  • Problems with pelvic health, primarily with the fallopian tubes or uterus

Treatment for unexplained infertility

In the absence of a definitive cause, treatments often recommended for people with unexplained infertility generally focus on the most likely causes.

Common treatments for unexplained infertility include:

  • Intrauterine insemination (IUI) — This type of artificial insemination involves washing and concentrating sperm then placing it directly in the woman’s uterus around the time of ovulation.
  • Clomid — Clomid pills can stimulate the ovaries to release more eggs per month, instead of just one. Most fertility specialists use Clomid in conjunction with IUI.
  • Timed sexual intercourse — The couple or woman with unexplained infertility will be instructed on how to time sexual intercourse to coincide with the woman’s ovulation. They should also have sexual intercourse regularly.
  • Injectable gonadotropins — Gonadotropin medications contain hormones that stimulate egg production in females and can treat low sperm count in males. Gonadotropin therapy is frequently combined with IUI treatment, resulting in better success rates with unexplained infertility.
  • Lifestyle changes — Women diagnosed with unexplained infertility should not smoke, should curtail consumption of alcohol and caffeine, and should maintain an appropriate weight, all of which can increase fertility. Men should also avoid obesity. Learn more about holistic fertility approaches.
  • IVF treatment — In vitro fertilization is the most effective (and most expensive) treatment for unexplained infertility. When IVF is performed for unexplained infertility, it often involves ICSI. In unexplained infertility cases, fertility doctors usually don’t turn to IVF until other treatments have been unsuccessful.