Unexplained Infertility
Unexplained infertility is really a misnomer. Standard testing comes up with no clear cut problem; however, there clearly is a conception delay. It may be due to occult lack of egg fertilization or implantation failure. In any case, it is very treatable. In some of these cases, there is some evidence of a reduction in ovarian competency. In other cases, sperm may have compromised function despite normal semen analyses.The conventional infertility evaluation in the female may include: medical history, physical examination, tests of blood hormone levels, ovulatory function, and hysterosalpingogram (HSG) (an x-ray of uterus and fallopian tubes). Laparoscopy, which involves the insertion of a thin, lighted telescope-like instrument into the abdomen to look at the uterus, ovaries, and fallopian tubes, may be necessary to exclude factors such as endometriosis and adhesions (scar tissue) which may not be apparent by HSG, although its utility has decreased sharply over the years. The conventional infertility evaluation in the male may include: medical history, physical examination, semen analysis, and hormonal testing.
The underlying problem with unexplained infertility may be discovered at the time of in vitro fertilization (IVF). IVF is a method of assisted reproduction that involves combining an egg with sperm in a laboratory dish. If the egg fertilizes and begins cell division, the resulting embryo is then transferred into the woman’s uterus. Evidence of egg fertilization, egg quality, embryo quality and implantation identifies what is working and what is not.
Critical factors to be considered in evaluating and managing unexplained infertility are the duration of infertility and age of the female partner. Any woman over 39 is at risk for age related conception delay. Furthermore, couples with unexplained infertility, who are infertile for more than three years, have protracted infertility with spontaneous conception rates of 1 to 2 percent per month. Infertile couples in which the female is greater than age 35 should be encouraged to actively pursue treatment after six months of trying to conceive, or if a known infertility related problem (e.g., endometriosis, history of irregular periods) is present.
Treatments for unexplained infertility involve fertility drugs as the cornerstone.In young patients it is combined with intra-uterine insemination for optimal results. In the older patient, they should be triaged directly to IVF. In any case, after failure of pregnancy with ovulation induction drugs for three to six cycles combined with intrauterine insemination (IUI) (inserting prepared semen directly into the uterus), IVF is frequently used.
The underlying problem with unexplained infertility may be discovered at the time of in vitro fertilization (IVF). IVF is a method of assisted reproduction that involves combining an egg with sperm in a laboratory dish. If the egg fertilizes and begins cell division, the resulting embryo is then transferred into the woman’s uterus. Evidence of egg fertilization, egg quality, embryo quality and implantation identifies what is working and what is not.
Critical factors to be considered in evaluating and managing unexplained infertility are the duration of infertility and age of the female partner. Any woman over 39 is at risk for age related conception delay. Furthermore, couples with unexplained infertility, who are infertile for more than three years, have protracted infertility with spontaneous conception rates of 1 to 2 percent per month. Infertile couples in which the female is greater than age 35 should be encouraged to actively pursue treatment after six months of trying to conceive, or if a known infertility related problem (e.g., endometriosis, history of irregular periods) is present.
Treatments for unexplained infertility involve fertility drugs as the cornerstone.In young patients it is combined with intra-uterine insemination for optimal results. In the older patient, they should be triaged directly to IVF. In any case, after failure of pregnancy with ovulation induction drugs for three to six cycles combined with intrauterine insemination (IUI) (inserting prepared semen directly into the uterus), IVF is frequently used.
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