Love, Loss and the Mystery of Unknown Infertility

How one couple navigated a diagnosis of unknown infertility (unexplained infertility)

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Amanda and her husband’s story began long before they ever realized they’d need fertility treatment to build their family. The pair, who grew up in Glendale, California, and attended school together from kindergarten through high school, became high school sweethearts in 2006. Once they connected, there was no looking back. The couple went to the same college and married in 2012, full of excitement for the future and the family they always dreamed of creating.

“We always knew we wanted kids,” Amanda says. “But we decided to take our time. We traveled for a couple of summers before we got serious about starting a family.”

Yet, when the couple did start trying to conceive, they found themselves facing an unexpected challenge – infertility. Amanda never thought growing her family would require more than a calendar and some good timing. But after four years of trying to get pregnant on their own, she and her husband were forced to confront a difficult reality—they needed help. What they thought would be a natural next step in their lives turned into a struggle that tested their patience and resilience.

Was it just difficulty or an unknown infertility cause?

After years of trying to conceive with no success, Amanda and her husband decided to seek medical help. They went to the Loma Linda University Center for Fertility & IVF. For the couple, choosing where to seek fertility treatment wasn’t a difficult decision. Both were deeply connected to the Adventist community, having grown up in its school system. So going to the Seventh-day Adventist university health system for fertility care felt natural.

“It felt like the obvious choice,” she explains. “I already had most of my healthcare providers there, so it was convenient. But beyond that, from the first meeting with Dr. Bareh, we knew we were in good hands.”

After running a battery of initial tests, the couple were surprised that no specific cause for their infertility was found. This diagnosis – known as unknown infertility, or unexplained infertility – was both a relief and a source of frustration.

The hopeful & defeating feelings of unknown infertility

Unknown infertility is a sometimes frustrating diagnosis for many couples. It occurs when standard infertility tests and the doctor’s clinical insights fail to identify a specific cause for a couple’s inability to conceive. According to the American Society for Reproductive Medicine (ASRM), approximately 15%-30% of infertile couples receive an unexplained infertility diagnosis.

“You feel somewhat hopeful that there isn’t an actual ‘reason’ for the infertility, because that might mean you can still get pregnant,” Amanda explains. “But at the same time, it’s defeating, because if there was a reason, maybe it could be fixed.”

Despite the uncertainty, Amanda and her husband decided to move forward with treatment, trusting in the expertise of Dr. Gihan Bareh, their fertility specialist at LLU Center for Fertility.

“We met Dr. Bareh and she immediately made us feel comfortable. She was proactive and committed to helping us get pregnant,” Amanda says.

Starting fertility treatment with IUI

With no clear cause for their infertility, the couple approached treatment with cautious optimism. Dr. Bareh recommended starting with intrauterine insemination (IUI), a less invasive and more affordable fertility treatment than in vitro fertilization (IVF). IUI involves placing collected sperm directly into the uterus to increase the chances of conception.

However, the first two rounds of IUI were unsuccessful, which Amanda described as “incredibly discouraging since everything kept looking ‘normal’ from a scientific standpoint.”

The emotional toll of the treatments was compounded by the constant vigilance required during the process. “We were tracking everything – my cycles, ovulation days – and each month, when my period came, it felt like another defeat.”

The couple decided to take a break from fertility treatments, hoping that a little time away might ease the stress they were feeling.

A pandemic pause and hope on the horizon with IVF

Their break from fertility treatments coincided with the onset of the COVID-19 pandemic, which added a layer of complexity to their situation. With so much uncertainty in the world, Amanda and her husband felt it wasn’t the right time to resume treatment.

But after a few months, one of their close friends, who had struggled with fertility herself, became pregnant. This gave Amanda and her husband the encouragement they needed to try again – this time, with IVF to address their unknown infertility.

“It was a turning point for us,” Amanda says. “Seeing our friends succeed gave us the push to dive into IVF.”

IVF came with its own set of challenges. During their first round of treatment, Amanda and her husband ended up with only a few viable embryos – fewer than they had hoped for. After discussions with Dr. Bareh, they decided to undergo a second round of IVF, which brought their total to five viable embryos.

Their first embryo transfer was unsuccessful. Undeterred, the couple decided to make lifestyle changes to improve their chances with the next transfer. Amanda leaned on a friend who had been through similar struggles, and she and her husband began adopting new habits, including becoming vegetarian, cutting out dairy and incorporating meditation and visualization into their daily routine. Amanda also began acupuncture with a doctor the clinic recommended. These changes, while difficult, gave her a renewed sense of hope.

“I remember going in for the second transfer, and Dr. Bareh commented on how much better my uterine lining looked. That gave me hope,” Amanda says.

The longest two week wait

After the second embryo transfer, Amanda and her husband entered the dreaded two-week wait – the period between the transfer and the pregnancy test. For Amanda, the wait was filled with anxiety and cautious optimism.

“I tried to stay calm and not get my hopes up too much,” Amanda says. “But I couldn’t help but notice small changes in my body that made me think I might be pregnant.”

Finally, after two weeks, Amanda went in for a blood test to confirm whether the transfer had worked. She waited at home for the call that would either bring tears of joy or another round of heartbreak. “My husband came home for lunch, hoping we’d get the news together, but the clinic hadn’t called yet,” Amanda says. “He had just left for work when I got the call from nurse Monica.”

The news was life-changing: Amanda was pregnant.

“I was stunned. I just started crying,” she says. “It was a moment I had dreamed about for so long.”

Amanda decided to surprise her husband when he got home from work. She had saved a special onesie that said, Promoted from dog dad to human dad, and waited by the door with it. When he walked in and saw the onesie, he froze in disbelief before picking her up and hugging her tightly.

A pregnancy filled with gratitude

The first trimester was a nerve-wracking time for Amanda, as she constantly worried about the possibility of miscarriage. But as the pregnancy progressed, Amanda and her husband began to relax and enjoy the experience. Although Amanda dealt with some health issues, including severe gastritis, the couple remained focused on the joy of their growing family.

“Dr. Bareh never gave up on us, even though our case was really difficult. The nurses were amazing too – Julie, Monica, Angie – they all made us feel special.”

For couples facing infertility, Amanda’s advice is simple: Find a doctor who makes you feel valued and lean on your partner for support. “You need a medical team that’s on your side and truly invested in helping you succeed,” she says. “And you need each other – no one else will understand what you’re going through like your partner will.”

While their journey was long and difficult, Amanda and her husband got the family they dreamed of – a dream they once feared might never come true. But their dream didn’t end there. Still not knowing why they couldn’t get pregnant with Micah and not thinking it was possible, they became pregnant – naturally.

“This resulted in us being stunned when we got pregnant after our firstborn was nine months old,” says Amanda. “It was definitely not planned to have two under age 2, but we are very fortunate to now have Micah and Lilah who have completed our little family.”