Understanding Unexplained Infertility

Many couples will present with infertility (more than one year of unprotected intercourse without conception), initially, without any obvious reason. Truly unexplained infertility, when a full work-up has been completed, is actually quite rare and occurs in less than 5% of our patients.

Often, a couple will be told they have "unexplained” infertility after the following three determinations: a semen analysis has shown normal looking sperm, a hysterosalpingogram has shown a normal appearing cavity and open fallopian tubes, and the patient has menstrual cycles that are regular. In more than 70% of these women, a problem inside the pelvis can be detected, which neither ultrasound scan or hysterosalpingogram x-rays can discern. The most common intra-abdominal problems causing infertility are endometriosis and pelvic adhesions (scar tissue). As these are usually invisible to standard diagnostic techniques, they require a surgical procedure (laparoscopy) to find and treat them. Only if the laparoscopy and the other studies are completely normal will the patient be determined to have truly unexplained infertility.

Subtle reasons for infertility include absent or abnormal eggs, failure of egg release at the time of supposed ovulation, failure of the fallopian tube to pick up the eggs, failure of the sperm to fertilize the egg, or failure of a fertilized embryo to implant in the uterus. Unfortunately, these events are all microscopic and elude normal diagnostic techniques.

In cases of truly unexplained infertility,in vitro fertilization (IVF) can bypass egg pick-up and sperm transportation, as well as bypass endometriosis and pelvic adhesions. Even with a diagnosis of truly unexplained infertility there is still a solution that could result in a successful pregnancy.