I was asked by a patient this week why I felt she had unexplained infertility when she had been told by her gynecologist that several issues had arisen during their infertility evaluation. Her previous physician had told her that she did not ovulate very well and that, at laparoscopy, he found endometriosis. She had been treated with clomiphene citrate (Clomid, Serophene) and experienced at least 8 ovulatory cycles with the medication. Also, endometriosis had been seen at her diagnostic laparoscopy and treated with a laser. Despite having been treated for both of these problems, she had not conceived.
A couple is considered to have a fertility problem if they have not conceived after 6-12 months of unprotected (not using contraception) sexual intercourse. The diagnostic evaluation for these couples include a semen analysis, hormonal studies to evaluate ovulation, a hysterosalpingogram to evaluate the uterus and fallopian tubes, a pelvic sonogram, and a diagnostic laparoscopy. If all for these tests are normal, the couple is considered to have unexplained infertility. In addition, if something is found to be abnormal, is corrected and the couple still has not become pregnant, then they are considered to have unexplained infertility, as well.
The woman whom I saw in the office felt that the cause of their fertility problem was her ovulation dysfunction and the endometriosis. However, one could argue that if these two problems were the cause, why didn’t she conceive once the problem had been corrected? This is a good argument and, thus, it is best to consider that, in her situation, there must be something else that is responsible for her infertility. Just because the reason for the infertility has not been discovered does not mean that there is not a reason, but rather that the cause has not be determined by the tests that are currently available.
Despite the fact that couples are really frustrated to hear that they have unexplained infertility, it is important for them to understand that there are procedures available to increase their chances of conceiving. The recommendation for treatment for couples who have had a problem and had it corrected but have not conceived is the same as patients with completely normal tests. These couples have an excellent chance of conceiving with clomiphene/ IUI, Gonadotropin/ IUI, or in vitro fertilization.
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