How Do We Explain Unexplained Infertility?
“Unexplained infertility.” It’s a maddening diagnosis. Infertility is defined as 12 months or more of natural conception attempts for women 35 or younger; 6 months or more of trying in women over 35 years of age. Throw in the “unexplained” and it means that all the basic infertility tests are normal (egg supply testing; imaging to check fallopian tubes and ovary; sperm analysis) and your doctor is left shrugging her shoulders because she can’t put a finger on why you’re not getting pregnant. You’re not alone—about 15 percent of couples suffering infertility share this diagnosis.
So how to explain the unexplained?
First, I try to counsel women and their partners that the current tests used to evaluate infertility are limited in scope. Normal test results don’t rule out the possibility of subtle issues affecting fertility. For instance, you might have an appropriate amount of eggs but the quality (chiefly impacted by age) might lower the eggs’ capacity to lead to a healthy pregnancy. Or maybe the semen analysis can’t pick up subtle sperm defects affecting fertilization. Fallopian tubes might look normal on testing but there could be microscopic issues within the tubes affecting their function. Endometriosis is definitively diagnosed via laparoscopic surgery – no longer part of the basic infertility work up so there are women diagnosed with “unexplained infertility” who might actually have endometriosis related infertility. General health issues such as undiagnosed celiac disease (not usually part of the infertility screening process) might affect fertility.
What can you do to improve your odds for having a baby?
If you haven’t already done so, improve your lifestyle habits.
· Cut back on caffeine consumption (less than 1-2 cups a day) as well as alcohol (down to 3-4 drinks a week) as there are studies suggesting that excess consumption of these may adversely impact fertility.
· Smoker? Quit. Smoking accelerates egg aging (and once those eggs are gone, they can’t be rejuvenated) and sperm quality.
· Definitely drop any recreational drug use.
· Maintain a healthy BMI (Body Mass Index) as both overly low or elevated BMIs have been associated with fertility (and miscarriage) problems.
· While stress isn’t generally thought to be a cause of infertility, it definitely doesn’t help. Try to alleviate stress and anxiety by seeking help from a mental health expert; working with an acupuncturist; meditating; doing yoga or some other workout that clears the mind (at least temporarily).
What medical treatments are available for unexplained infertility?
Just because you and your doctor can’t tease out the cause of your fertility problems doesn’t mean you won’t be able to have a baby. Treatments such as fertility medications combined with IUI (intrauterine insemination) or in vitro fertilization (IVF) can dramatically improve pregnancy rates for women/couples struggling with unexplained infertility. Expectant management—just continuing to try naturally each month—yields just a 1-4 percent monthly pregnancy rate. In younger women (ie <37), clomiphene (a commonly used fertility pill) with intrauterine insemination bumps the monthly pregnancy rate closer to 9-10 percent while IVF pregnancy rates jump to 25-40 percent or more in women under the age of 40. If these methods don’t succeed, IVF using donor eggs lead to pregnancy rates of 50 percent or higher.
What if you definitely don’t want to use fertility treatments?
Keep trying naturally as there is a low but ongoing chance for conception. Ask your doctor if surgery to look for and treat endometriosis (if found) might be reasonable. Studies show that removal of endometriosis helps improve pregnancy chances post-operatively.
What’s on the horizon?
As science/technology improve in uncovering reasons for infertility, the percentage of “unexplained” infertility should drop. One example is a new blood test—Fertilome—that screens for genetic variants associated with infertility. Though this information is currently just informative, the hope is that, in the very near future, treatments may be tailored to these genetic findings.