Unexplained Infertility: What It Means and What You Can Do

What if a couple’s test results are normal for parenthood, but they might not be able to have children?  Inability of a couple to conceive after one year of regular unprotected intercourse is known as infertility.

On the other hand, suppose that a 32-year-old woman and her 35-year-old husband had been trying to get pregnant for more than two years.  Tests reveal that she ovulates regularly, her ovarian reserve is normal, her fallopian tubes are open, and her husband’s semen analysis is normal.  And yet they are unable to conceive.  This is known as infertility that is unexpected or unexplained.

Additionally, between 10-15% of married couples in India experience infertility, which is a rising public health issue.  The biggest challenge, however, is that 10–30% of these cases are unexplained infertility, in which a couple meets all the requirements to become parents. Still, no obvious medical cause can be found.

Definition: Unexplained infertility

Fertility testing sometimes fails to identify the cause for an individual’s or couple’s infertility is termed as unexplained infertility.  A thorough fertility evaluation will also prompt that females have no structural problems or uterine abnormalities, have regular ovulation, fallopian tubes are open and free of obstructions, a healthy egg count or ovarian reserve, and normal levels of the hormones required for reproduction produced by your brain.  And a male’s semen analysis will show normal count, quantity, motility, and form.

When a couple under the age of 35 is diagnosed with unexplained infertility, they should have been attempting to conceive for at least a year. And, those more than 35 or older should be trying to conceive for at least six months.

Unexplained infertility doesn’t mean a couple can never become parents. Many doctors and researchers say the term itself is not fully accurate. This is because whether someone is called “unexplained infertile” often depends on how many tests are done, how detailed they are, and how advanced the medical tools are. In simple words, sometimes the reason is just hidden or missed, not truly absent.

Now, what are the Causes Behind it? Well, there is no exact reason found behind this challenge but some possible reasons for unexplained infertility include:

• Latent Tuberculosis (Genital TB), particularly in India may damage endometrium or fallopian tubes, often without any symptoms.
• Endometriosis, insulin resistance, deficiencies in vitamins and minerals can affect the reproduction process.
• For example, celiac disease (a gluten allergy), diabetes and thyroid conditions contribute to infertility, autoimmune disorders like lupus, rheumatoid arthritis or autoimmune thyroiditis, antiphospholipid antibody syndrome (APS) can interfere with the implantation or attack reproductive tissues.
• Thick cervical mucus may work as a barrier. A woman’s cervical mucus contains antibodies that attack sperm, preventing fertilization, called immunological infertility.
• Although ultrasound and blood tests can show the number of eggs, they cannot provide a precise indication of the quality of the eggs. Likewise, a sperm analysis provides information on the sperm. However, there can be additional sperm-related problems that lead to infertility that cannot be explained.

Can it be treated? Yes, unexplained infertility is an emotional phase because there’s no clear problem to solve. And, couples may feel stuck or helpless. But, many couples go on to conceive, either naturally or with assistance. Here are some of the methods, such as:

1. The very first thing is to consult a doctor, to check if it is infertility only or unexplained infertility. Doctors may suggest waiting a few more months before starting treatment. Sometimes, spontaneous conception does occur. During this time, tracking ovulation, maintaining a healthy lifestyle, and reducing stress can help.
2. Following positive lifestyle modifications like maintaining ideal weight, eating a proper balanced diet, avoiding tobacco and alcohol consumption, reducing caffeine intake, following proper sleeping habits, and managing stress. Adopting these as discipline will not treat infertility directly but will create a supportive environment for conception.
3. Yes, Assisted Reproductive Technology (ARTs) such as Intrauterine Insemination (IUI), In Vitro Fertilization (IVF) can help.

So, the challenge here is to analyze the exact cause behind the infertility which becomes a barrier to start a treatment. We as health experts are always studying to learn more about human bodies functioning. And, advances in reproductive science may eventually uncover these hidden causes, but for now, there are certain areas which still remain outside the scope of regular testing.

(Dr. R Suchindra, Senior Consultant – Reproductive Medicine, Milann Fertility Hospital, Bengaluru)