Unexplained Infertility Explained

Unexplained Infertility Explained

The term, Unexplained Infertility is used when the sperm quality meets normal standards, the woman is likely to be ovulating regularly with a good ovarian reserve/egg supply, and a “dye test” (hysterosalpingogram) proves that the fallopian tubes are open.  Also, if the doctor suspects the answer may be within the women’s pelvis, then a surgical procedure known as laparoscopy is performed.

Approximately 30% of couples struggling to get pregnant are told that they have “unexplained infertility“. After examinations and tests, the doctor states there is no known medical reason to explain why they haven’t conceived.

An unexplained infertility diagnosis may be justified if it has been shown that,

  1. You are ovulating regularly
  2. Your ovarian reserves are good. (Evaluated with blood work and/or an antral follicle count.)
  3. Your fallopian tubes are open and healthy. (Evaluated with an HSG.)
  4. Your partner’s semen analysis is normal (including total count, sperm movement, and sperm shape.)
  5. There are no serious uterine fertility issues. (Evaluated with a hysteroscopy.)

If any of the above has not been evaluated, a diagnosis of unexplained infertility may be premature.

Reasons for unexplained infertility

1. Autoimmune Disorders

Inflammation and autoimmunity are distinct processes, though they share a common tactic: They cause the immune system to target any perceived invader, including an embryo.

Researchers have identified upward of a hundred autoimmune disorders that cause the body to mistake its own tissues for intruders. Some of the more familiar varieties — Hashimoto’s thyroiditis, rheumatoid arthritis, and celiac disease — may be linked to conception failure and recurrent miscarriage.

Some 75 percent of autoimmune sufferers are women, so an early diagnosis is key for those seeking to get pregnant. Diagnostic results, however, can take some time — an average of four years and four doctors, according to the American Autoimmune Related Diseases Association.

2. Thyroid Malfunction

Autoimmune issues involving the thyroid exert an especially potent effect on fertility. Hashimoto’s, an inflammatory response in which the body attacks the thyroid glands, accounts for 90 percent of hypothyroidism, and a 2014 study published in the International Journal of Endocrinology found that 47 percent of patients with Hashimoto’s had difficulties becoming pregnant.

Thyroid malfunction puts a woman at greater risk for anovulatory cycles, in which no egg is released, though she may still regularly get her period. Additionally, lower thyroid levels are associated with decreased sex hormone binding globulin, which can “interfere with growth and development of follicles and get in the way of proper FSH and LH [hormone] surges associated with ovulation,” according to Dana Trentini and Mary Shomon, authors of Your Healthy Pregnancy With Thyroid Disease.

3. Food Sensitivities or Intolerances

Food sensitivities trigger low-level inflammation, making them potential suspects in any case of infertility. The same is true of food intolerances, which can occur when the body is deficient in an enzyme necessary to break down certain food substances, like lactose in dairy or gluten in wheat. If you have a food intolerance, eating even a small amount of the offending food can trigger systemic immune activation, causing widespread inflammation.

4. Toxic Exposure

We’re products of our environment, and it has an impact on fertility. A 2005 study by the Environmental Working Group found 287 industrial chemicals, pollutants, and pesticides in the umbilical-cord blood of 10 U.S. newborns chosen at random. Many toxins have been shown to trigger inflammation, suppress the immune system, impair fertility, or result in pregnancy complications and birth defects.

One research study found higher blood concentrations of mercury in infertile couples. Another observed significantly higher levels of lead in the blood of infertile women. Experts posit that heavy metals damage the immune system’s ability to distinguish between the body’s own tissues and hostile invaders, creating the conditions for an autoimmune attack.

5. Chronic Stress

Chronic stress is “anything that overwhelms your body’s capacity to respond effectively to the challenges you’re exposed to,” explains Romm, and it can affect fertility by keeping the nervous system activated, triggering low-grade inflammation, and interfering with hormone production.

The pressures of infertility, of course, also contribute to overall stress loads. “The diagnosis [of] ‘unexplained infertility’ can leave people devastated and heartbroken,” says Grunewald. “It adds to the stress that could be preventing conception in the first place. There may be peace of mind in knowing what is behind your infertility, even if the news is not what you’d hoped.”

Treatment for unexplained infertility

  1. Lifestyle changes recommended (like weight loss, quitting smoking)
  2. Continue to try on your own (if you’re young and willing) for six months to a year
  3. Clomid or gonadotropins along with IUI for three to six cycles
  4. IVF treatment for three to six cycles
  5. Third-party IVF treatments (like using an egg donor or surrogate)


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