What??? What do you mean you don’t know? My husband and I have been through all the tests you recommended and there are no answers? If it’s not me, and it’s not him, then what’s keeping us from conceiving?

An emotional reaction, many times in the form of increased anxiety and sadness or even depression, often follows the diagnosis of “unexplained infertility”. Not to know the “whys” can be obfuscating, exasperating, and even unbalancing, sometimes leading to emotional trauma.  It can affect the couple’s relationship. If a specific cause is discovered the situation is difficult, too, but knowing the root of the problem makes it more tolerable.

Not to make you feel better, unexplained infertility is found in 20-25% of couples. Failure to establish a causative diagnosis follows the analysis of the partner’s sperm, and the woman’s uterus, tubes, and ovulatory status. At that point couples can be directed to more “sophisticated” tests searching for more rare causes of immunologic, systemic and/or chromosomal/genetic origin. But sometimes subdued anomalies can be found with more common tests such as an in-depth analysis of the ovarian reserve, a hysteroscopy (ruling out endometrial polyps, scar tissue, or inflammation -endometritis), novel but still unproven endometrial receptivity assays, and nowadays checking for degrees of sperm DNA fragmentation.

Certainly, it is possible that there are “subtle defects” that can affect tubal transport and egg pickup, ovulation and/or egg quality, sperm function, and even implantation. Many of those are still tough to identify even today.

Given this dreadful diagnosis, you may elect to keep trying on your own (“expectant management”). But keeping in mind the emotional effects and the ticking of the ovarian clock, that is not what I recommend.

So here is the good news: (1) Not knowing the cause of your infertility means that all therapeutic options can be explored, provided you are perseverant and with available resources; (2) couples with unexplained infertility directed to IUI therapy have a relatively good success rate; (3) but in the end, if other approaches fail, IVF becomes a logical and very successful way to intervene, with very high rates of conception, particularly if the woman is under 38 years of age. In fact, many undiagnosed couples will achieve a pregnancy with IVF, most typically augmented with ICSI, to also eliminate the impact of an occult male factor.

Do not let the diagnosis of unexplained infertility frustrate you; rather use it as a motivational factor to follow these recommendations. And keep hope, which is based on real data.

For further information please contact Sher Fertility Institute at (646) 792-7476.