People visit a fertility clinic for answers as to why they can’t get pregnant or carry a pregnancy to term. While up to 80% of these people, after initial testing, will receive a diagnosis and treatment plan, approximately 20% will be diagnosed with unexplained infertility. This can be incredibly frustrating, but isn’t a reason to give up, it usually just means you have to look further for the answer.
Unexplained Infertility Challenges the Fertility Clinic to Look Further for the Answer
Approximately 80-90% of people visiting a fertility clinic because they are unable to conceive or carry a pregnancy to term will be diagnosed and given a treatment plan after initial testing. The diagnostic tests available now cover all the major obstacles. If the fallopian tubes are blocked or there is no sperm, these are obvious major obstacles to becoming pregnant.
However, there are no tests available for more subtle infertility factors such as inadequate egg quality which could result in fertilization failure. The 10-20% of people with fertility problems that don’t show up in initial diagnostic testing are given the diagnosis of “unexplained infertility.” While this sounds like a devastating diagnosis it doesn’t have to be, it usually means that the fertility clinic has to look at factors that are not as easy to test for.
People with the diagnosis of “unexplained infertility” have passed all the standard diagnostic test but aren’t getting pregnant. Their chances of achieving a pregnancy that can be carried to term without some form of fertility treatment is only 1-4% per month. That is much lower than the normal 20% chance of pregnancy per month that younger couples without fertility issues have.
The stress people are already experiencing from the infertility is heightened with the diagnosis of “unexplained infertility” because it sounds like something that the fertility clinic doesn’t know how to deal with but that is not the case. When the fertility center realizes that the fertility issues being dealt with aren’t the more common ones they start looking at different protocols to see what will work.
Fertility treatment protocols are not one size fits all, the fertility center custom designs a protocol to fit each fertility issue. They also have a list of protocols that they use in order, each one that doesn’t work gets them closer to the one that will be successful.
Standard treatment for people with unexplained infertility is 3 cycles of Clomid and intrauterine insemination (IUI). If this treatment plan is not successful, then the fertility center will recommend IVF as their next treatment option.
There are multiple reasons for jumping straight to IVF. One of the primary reason is that there are diagnostic benefits of IVF that cannot be detected in any other way. Women who have an excellent ovarian reserve can have inadequate egg quality. This can be seen under the microscope at the time of egg retrieval. Couples with mature eggs and normal semen parameters may have poor embryo development after fertilization, which can also only be seen during IVF. Other issues that sometimes show themselves during IVF are problems with embryo development and implantation issues.
Once these issues are discovered they can be addressed, generally with IVF and the procedures that come before the actual implantation of the embryo, like preimplantation genetic screening (PGS). Other options include:
- Zygote intrafallopian transfer (ZIFT) where the fertilization occurs in the lab, but the embryos are placed in the fallopian tube instead of the uterus.
- Gamete intrafallopian transfer (GIFT) where the egg and sperm are fertilized inside the woman’s fallopian tube, the egg is never removed from the body.
- Intracytoplasmic sperm injection (ICSI), which is commonly used with IVF. ICSI involves a single sperm being injected into a mature egg in the lab and the embryo being transferred to the uterus later, possibly after genetic testing of the embryo.
IVF treatment for unexplained infertility has an average success rate of 50%, which is excellent. The fertility center can control the risk of multiple gestation (twins, triplets, etc.) by limiting the number of embryos that are implanted. A woman’s fertility can also be preserved by creating surplus embryos, which can be frozen at her current age and transferred later when she is ready for another baby.
Someone diagnosed with unexplained infertility should not be too discouraged or lose hope. It means that there is a bigger puzzle for the fertility center to solve before you are on your way to parenthood. With the technology available today, especially IVF, most cases of unexplained infertility are eventually explained and treated turning the “unexplained infertile” into parents.
Sophie Yang is a passionate writer who loves writing about the reproductive system and what all treatments are available for infertility. Through her writings and blogs, she aims to spread awareness among as many people as possible about this. Sophie works at Fertile, a renowned fertility clinic in Southern California, as an infertility specialist. When she is not writing or working, you can find her gardening, making pancakes.