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What is Unexplained Infertility and How is it Treated?

By: Dr. Dan Nayot, MD, M.Sc., FRCSC, REI

 As the name implies, ’unexplained’ infertility means according to everything we’ve checked, we haven’t been able to pinpoint the reason you have not been able to get pregnant. Whether you’ve never been pregnant (primary unexplained), or if you’ve achieved a pregnancy before but are having difficulty now (secondary unexplained), this is a frustrating and upsetting diagnosis. As doctors, if we don’t know what the issue is, it’s hard to pinpoint the right solution or treatment. Sometimes, it’s a process of trial and error, and it calls for a joint effort between the patient and the doctor. That’s why we work with a patient or couple very closely to find the best solution for them. 

Fertility doctors look at the big things first: we look to see if you are ovulating, are your tubes open, is your uterus normal, are your hormones normal, is the sperm normal, and are you timing intercourse properly. When all these things appear to be normal and there is a problem getting pregnant, there is also lot going on at a microscopic level which we can look at, so we will dig a bit deeper. What we talk about on the microscopic level are the things we can measure in tests such as ultrasound findings, blood work and sperm analysis. And then, beyond these, there are all the things we can’t see, the things that are going on inside our bodies. So, maybe the sperm and egg aren’t binding. Maybe there is a beautiful embryo that’s inside, but it isn’t implanting. While these are things we are not going to pick up with testing, these are things we can sometimes control with interventions such as IUI or IVF which may be suggested by your doctor. 

Whether you should proceed with something like IUI or even IVF really depends on your scenario. Using the approach of fertility drugs and IUI, for example, we are essentially timing the release of eggs and we are trying to put them closer to better sperm, so in theory that makes sense: timing the optimal release of eggs, better sperm, closer together. 

Likewise, the technology of IVF with ICSI continues to improve, and pregnancy rates continue to get better and better. IVF with ICSI is one of the most successful treatments we can offer patients, so sometimes when we’re helping people achieve a pregnancy, we offer the best option possible early on. We talk about IVF in two ways: obviously we are trying to help you reach a pregnancy, but we’re also trying to uncover answers. With this technology, this is the first time we’re seeing sperm and egg in the lab and how they’re interacting, how they’re fertilizing, how they’re growing. So hopefully we’ll get you pregnant, but even if we don’t, we’ll have more information to guide our next steps.

In addition to medical interventions, I am a big believer in naturopathic or alternative therapy. I think it is worthwhile to look at all approaches, especially in the cases of unexplained infertility because we are looking for any sort of help with diagnostics or therapeutics, and different approaches or different angles might help us uncover and treat the issue. Naturopaths look at things a little bit differently: they talk about overall health, egg quality, sperm quality, stress reduction, sleep hygiene, well balanced diet, exercise regimen, and making sure all supplements are optimal. 

In terms of emotional aspects associated with unexplained, there is perspective and persistence: every couple deals with this differently. Some people say unexplained? Fantastic! You haven’t found a problem so let’s move forward. Some couples take it very differently and say this is troublesome because you haven’t found the problem so how are you going to help us? One of the key aspects of emotional counselling is to give the couple strength to be persistent. Because with persistence and enough attempts, your odds are just going to get higher. 

It is also important to remember that the diagnosis of unexplained has really changed over the years. Because infertility medicine is getting better and better, what was unexplained 10 years ago, may have answers now. We are hopeful this positive trend will continue.