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What is unexplained infertility?
Unexplained infertility affects around 15% of couples undergoing fertility treatment. In medicine, the term idiopathic infertility is used rather than unexplained infertility. In fact, the term idiopathic means that there is no cause initially found for your infertility.
Idiopathic infertility is therefore defined as the absence of causes identified after questioning by the doctor (whether or not regular cycles are evidence of ovulation problems) and after the first-line complementary tests carried out on couples consulting for infertility.
These tests include an ultrasound scan of the uterus and ovaries, a hysterosalpingogram or hysterosonogram to assess the permeability of the fallopian tubes, a hormone test at the beginning of the cycle, and a spermogram.
If these tests come back normal, the doctor can conclude that there are no abnormalities of the uterus, that your ovaries are functioning normally, that the fallopian tubes are not "blocked", and that the spermatozoa are in sufficient number with normal mobility and morphology. He will therefore operate the term "unexplained infertility" to describe your case.
A case of infertility that's not so unexplained after all...
Among all the couples we meet during their fertility journey, it is likely that a certain number of them have sexual problems that they dare not tell us about out of modesty or shame. We will then label infertility as unexplained, whereas there may be a problem with vaginismus, ejaculation, erection, or sexual desire within the couple that was not declared to the doctor during the initial consultations. Psychosocial stress may also play a role in unexplained infertility.
In the course of your care, you may also be offered surgery to look for a cause of infertility and to detect any endometriosis not diagnosed on ultrasound.
On the other hand, it is possible that, at a later stage, a cause may be found that could explain your difficulties in conceiving. In fact, after an initial attempt at in vitro fertilisation (IVF), your doctor may finally discover the problem at the root of your infertility.
After the treatment cycle and thanks to the laboratory evaluation of your oocytes, the fertilisation process, and the "quality" of the embryos, he will be able to tell you whether or not there is an explanation for your fertility problems.
Therefore, only at a later stage will unexplained infertility finally find its explanation: a problem responding to treatment, an oocyte or sperm "quality" problem, a fertilisation problem, an embryo "quality" problem, an implantation problem, etc. It was impossible for your doctor to look for this type of problem before initiating treatment, as IVF cannot be started purely for diagnostic purposes.
Treatments for unexplained infertility
In the event of unexplained infertility following the initial tests described above, your doctor may suggest several types of treatment depending on your age and the duration of your infertility. In most cases, the first step is low-dose hormonal stimulation using tablets or subcutaneous injections.
After a few days of treatment, you will be given an ultrasound scan to determine when you are ovulating. Your doctor will then be able to tell when you are due to ovulate and will either recommend that you have regular intercourse with your partner around this time or schedule you for intrauterine insemination (IUI).
In vitro fertilisation (IVF) may be proposed in the case of "unexplained" infertility, either immediately, depending on your age or the duration of your infertility, or at a later stage after the failure of hormonal stimulation combined with "planned" sexual intercourse and/or after the failure of intrauterine insemination (IUI).
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Written by:
Dr. Pierre-Emmanuel BOUET, M.D., M.SC, Department of obstetrics and gynaecology and medically assisted procreation
Angers University Hospital Centre
