Unexplained Infertility
The diagnosis of unexplained infertility is used when no cause for the infertility can be found in either partner in spite of testing (see tests listed below).
Up to 1 in 10 infertile couples have unexplained infertility. This highlights that fertility treatment is an evolving science and current knowledge is far from complete. Patients with unexplained infertility may achieve a pregnancy with or without treatment however it is unknown if this will happen. Also the time taken to achieve a pregnancy may be an important factor in deciding upon treatment.
Treatment of unexplained infertility
Many patients with unexplained infertility will first try ovulation (cycle) tracking and if unsuccessful will progress to artificial insemination and lastly IVF. If time is a significant factor then patients may try cycle tracking and then go straight to IVF. The advantages of IVF are that it has higher success rates and also that it is a diagnostic tool as well as a treatment because embryologists are able to see if the woman’s oocytes are fertilised and also monitor how the embryos develop to blastocyst stage. If there is a problem with fertilisation or embryo development this can aid diagnosis and guide future treatment.
Tests for the male partner:
The sperm count should be completed prior to the female partner’s investigations.
a. Sperm Count:
Normal result is at least 20 million per ml, 50% motile (moving), and greater than 4% normal morphology(shape/form).
If low, the test should be repeated as results can vary due to a number of factors (see Causes of Infertility>Male Infertility for further information).
b. Sperm DNA Fragmentation:
To assess the level of damage to the structure of chromosomes in the sperm.
Tests for the female partner:
a. Diagnostic ultrasound:
Usually done via the vagina, is a relatively inexpensive and noninvasive test done in a radiology practice. The patient’s doctor will receive a report stating any abnormalities detected.
b. Blood Tests:
By having several blood tests during a full cycle, checks can be made on the levels of oestrogen, LH, and progesterone, as well as FSH . See Treatment Options>Cycle Tracking for further information.
c. Endometrial biopsy:
This is done by taking a small sample from inside the womb to check whether the lining of the womb is ‘in phase’ with the time of the menstrual cycle. This test can be done without an anaesthetic, or as part of a full curette.
d. Hysterosalpingogram
This X-Ray of the fallopian tubes can determine whether the internal shape of the uterus is normal and if the fallopian tubes are blocked.
e. Laparoscopy:
This investigation, done under general anaesthetic, allows the doctor to visualise the tubes, ovaries and other pelvic structures.
f. Temperature Chart:
Ovulation may be detected by a rise in body temperature.
g. Hostility: (these tests are not used as frequently as in the past)
- Post coital test: At the time of ovulation, mucous is extracted from the cervix 8-10 hours after intercourse and the activity of the sperm is assessed.
- Sperm antibodies: Mucous and sperm are collected and mixed with coated beads in the laboratory. If the sperm are not able to move properly and bind to the beads, sperm antibodies are present.
Other factors
These are some conditions which have been associated with unexplained infertility, however these do not always cause infertility:
- psychological causes such as stress;
- minimal (very mild) endometriosis;
- adhesions in the uterus; and
- mycoplasma infection.