Unexplained Infertility

Unexplained infertility refers to an unremarkable infertility evaluation. In other words, semen parameters were within normal limits, at least one fallopian tube is patent, the uterine cavity is normal, and menstrual cycles are regular with evidence of regular ovulation patterns. Unfortunately, a large proportion of infertile couples suffer from unexplained infertility, affecting up to 30% of couples. A normal evaluation does not indicate that there is no pathology, it simply means that available conventional testing failed to identify the cause of infertility.  Most common causes of infertility in these cases are related to poor egg or sperm quality, failed fertilization, poor embryo development or defective implantation, most of which there are still no diagnostic tests.

Treatment

Since the specific cause of unexplained infertility is unknown, treatments are all considered empiric. Treatment is often approached in a stepwise fashion, but could differ based on your specific situation. Without treatment, the chance of pregnancy in a given month is approximately 1-2% and only ~14% of couples with unexplained infertility will achieve pregnancy spontaneously within 7 years.

First line treatment for unexplained infertility is a combination of ovulation induction using clomiphene citrate with intrauterine insemination (IUI), which confers a 9-10% success rate per cycle. After 2-3 failed cycles of ovulation induction + IUI, the next step is proceeding with IVF. IVF confers the highest success rate yielding an average live birth rate of 29%. Overall, IVF is the most effective treatment option for couples with unexplained infertility.