Unexplained Infertility

Being given the diagnosis of unexplained infertility can be confusing and frustrating. It can be hard not to know the exact cause of why you’re struggling to conceive. However it is very common, affecting around 1 in 4 with infertility. Here we talk about how it is diagnosed and the chances of conceiving after receiving a diagnosis.

What is unexplained infertility?

Unexplained infertility is when no cause of infertility can be found in either partner. That means the woman is ovulating regularly, has open fallopian tubes with no adhesions, fibrous growths or endometriosis and the man has normal sperm. Intercourse must also be taking place frequently, at least twice a week, particularly around the time of ovulation, and the couple must have been trying to conceive for the previous one to two years.

In the UK, unexplained infertility accounts for around 1 in 4 cases of infertility. 

What are the indicators?

Unexplained infertility is where both partners or a person with a uterus and sperm donor have normal test results but are still struggling to conceive. As such the main indicator is being unable to conceive for an extended period despite having regular intercourse.

What tests can be done?

Unexplained infertility is always a diagnosis of elimination. That means doctors must test for the possible causes of infertility and only diagnose your case as unexplained once you and your partner (if you have one) have been fully evaluated. 

An unexplained infertility diagnosis may be given if:

  • There are no serious uterine fertility issues. (Evaluated with a hysteroscopy.)
  • You are ovulating regularly. (Confirmed with a progesterone test)
  • Your fallopian tubes are open and healthy. (Evaluated with a scan called HSG.)
  • Your ovarian reserves are good. (Evaluated with AMH or FSH and/or an antral follicle count.)
  • Your partner’s semen analysis is normal (including total count, sperm movement, and sperm shape.)

Unexplained infertility can be a controversial diagnosis because sometimes people are given it when actually they haven’t had all the tests needed.

How can unexplained infertility be managed?

Currently UK guidelines say that clomifene citrate (or other fertility drugs taken by mouth) should not be offered because it has not been found to improve the chance of pregnancy compared with trying for a baby naturally.

If you have been trying to conceive through regular unprotected sexual intercourse for 1 – 2 years (this can include 1 year of trying before you had your fertility tests) and have not become pregnant, you may be offered IVF on the NHS depending on local guidelines. 

If you aren’t eligible for NHS treatment you may wish to consider self funding IUI or IVF.  

It is still possible to conceive at home with unexplained infertility, although the chances of success are unfortunately lower than for those without. You may wish to continue to try at home while waiting for treatment or if treatment options aren’t available to you for financial or personal reasons. 

You may also wish to try lifestyle changes such as stopping smoking if you do, reducing alcohol consumption and maintaining a healthy weight.

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