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Unexplained infertility is a condition where when all the tests are done for evaluating the male and female ,the test results come normal. For example ,the egg reserve in the form of Anti-Mullerian Hormone and Antral follicular count, the Sperm test, the Tube test and the basic pelvic ultrasound .We check the uterus the endometrium and rule out structures like fibroid ,polyp and Hydro salpinges . About one third of couples suffering from infertility come under this category. Sometimes it needs diagnostic laparoscopy to confirm the diagnosis of unexplained infertility. The ultrasound may not pick up small patches of endometriosis and adhesions which can be causes of infertility. Therefore, in unexplained infertility we have to rule out all causes like polycystic ovary, endometriosis, male factor and tubal factor.
We must understand that unexplained infertility does not mean there is no cause. Pregnancy is a process consisting of thousands of micro steps. We can only test basic things like the egg, sperm, uterus and surrounding structures, but whether the tube is able to pick the egg, whether the sperm is fertilizing the egg in the tube, whether this fertilized egg which is the embryo is able to swim down the tube and implant into the uterus which again involves thousands of divisions and microcapillary formation which is called implantation- whether all these processes are happening or not cannot be tested. Many times couples ask the doctor when all tests are normal why aren’t we getting pregnant. It basically means that the microprocesses of pregnancy and implantation are not happening and we cannot test those unfortunately, so it is better we move on to advanced form of reproductive treatment and get the pregnancy sooner rather than later.
The treatment of unexplained infertility depends on the age of the lady, the duration of infertility and the treatment they have had so far for the same. If the lady is young ,duration is less than 2 years and there is not much treatment ,then medication aiding in ovulation induction followed by natural trying and IUI can be tried. These ,if extended for 3 to 6 months can give good pregnancy results. It has been seen that mild super ovulation in women with unexplained fertility increases the chance of success.
For women who are more than 34 years of age, duration of infertility is more than 2 years and who have had rigorous treatment in the form of medications and IUI, the next best option is to go for IVF. It is better that we resort to IVF at this point rather than wait when the lady reaches 38 or 39 when the ovarian reserve and the ovarian capacity becomes low and it is more difficult to get the couple pregnant.