Unexplained infertility: what to do?

Around one in five couples fail to conceive naturally and turn to fertility clinics for help and advice.

It will be a long and tortuous journey and studded with various analyzes to trace what causes the difficulty or impossibility of conception. Most of these couples will be able to have an infertility diagnosis and will be able to decide with the doctors on the treatment they wish to undergo in order to achieve pregnancy.

For about 20% of couples, however, the diagnosis will be that of unexplained infertility . This means that no known cause of infertility has been found. A decidedly frustrating outcome that leaves a bad taste in the mouth.

What is considered ‘normal’?

Understanding human fertility is complex, because there are many factors that can come into play and influence couples’ chances of having a child.

A woman’s age, and to a lesser extent a man’s, can have an impact, as can stress and their lifestyle.

Most scientific literature suggests that 95% of women under the age of 35 conceive within 2 years of trying.

Therefore, a young couple who are trying to become pregnant should not worry that they will be infertile after just a few attempts. It’s probably a matter of time (remember that the maximum probability of conception under ideal conditions does not exceed 25% per menstrual cycle).

Women who are over 36 (and especially over 40) may take longer to get pregnant naturally. In this case, however, the tests are recommended after only 6 months of unsuccessful targeted attempts.

For younger couples in the absence of apparent problems, they are asked to wait at least a year of targeted attempts before proceeding with the checks.

 A frustrating diagnosis

When pregnancy doesn’t arrive, we usually undergo a series of specific analyzes that evaluate the most common causes of female sterility and male sterility.

The most common causes are ovulatory problems or blocked fallopian tubes for women , and problems with sperm count and quality in men .

The most common and accurate tests that are currently used for diagnosis are:

• lo spermiogramma
• blood tests to check women’s hormone levels
• ultrasound monitoring to verify ovulation
• specific ultrasound scans to monitor the state of the ovaries (e.g. antral follicle count ) and tubal patency (sonohysterosalpingography).

If a doctor is trying to understand what are the causes of infertility for a couple, he must understand if the woman is ovulating, if the tubes are patent, if the man produces sperm, in what quality and quantity, for how long they have been trying pregnancy, whether they have intercourse on fertile days, how old they are…

Based on these data, you can already have a good idea of ​​the couple’s ability to conceive naturally.

If the test results are all satisfactory and the couple has already tried for more than two years without success, the diagnosis obtained is that of unexplained infertility.

On the one hand, there is the relief of not having anything of importance, on the other, the frustration of not having answers that show the light down the road.

Assisted fertilization also for unexplained infertility

When couples receive a diagnosis of unexplained infertility , the solution may be to face an assisted fertilization process , in the same way as those couples who have found the cause of their infertility.

In Vitro Fertilization ( IVF) is considered the best approach because it bypasses some issues and can give an indication of what is causing her or him to be infertile that wasn’t evident with testing.

Your doctor can check how your ovaries are responding to medications, some tubal problems are cleared up, and you can check how well sperm are able to fertilize an egg.

The IVF success rate for couples with unexplained infertility is comparable to other infertile couples.

However, assisted reproduction treatments are not always the right way to go.

Some couples choose to continue trying naturally, followed up by a doctor periodically. Will pregnancy come? Yes, but it is not known if and when.

The alternative to PMA or natural attempts to the bitter end is heterologous fertilization when the woman’s ovarian reserve is very low.

Medical advances are always around the corner and probably those 20% of cases of unexplained infertility will find an answer over time.

In the meantime, it’s up to the couple, with the support of the experts, to choose the path that best suits their needs as individuals, couples and aspiring parents.