Having a diagnosis of unexplained infertility is not only frustrating but also frightening. The term “unexplained infertility” sounds as if the diagnosis is grave and no other options remain for the treatment. However, this is far from reality. “Unexplained infertility” just means “unexplored infertility” i.e., the cause of infertility has not been found yet.
How do we define unexplained infertility?
A diagnosis of unexplained infertility is given when you have tried naturally for a period of 1 year and have not conceived with the following normal results on evaluation:
1. Normal ovarian reserve with ovulation happening in each cycle
2. At least one fallopian tube is open on hysterosalpingography
3. Semen parameters are normal
4. No obvious uterine abnormality on ultrasound or hysteroscopy
What is the incidence of unexplained infertility?
The incidence of unexplained infertility is approximately 5% to 10%.
What are the most common causes of Unexplained infertility?
1. Hostile cervical mucus
2. Minimal to mild endometriosis
3. Poor egg quality
4. Poor sperm quality
5. Abnormal endometrial receptivity
6. Idiopathic i.e., everything may be normal
What can you do to improve your fertility?
1. Exercise daily for 45 minutes
2. Include yoga and meditation in your routine to reduce stress
3. Eat wholesome homemade healthy food. Do not undergo any form of a strict diet.
4. Sleep early and wake up early.
What are the treatment options available for Unexplained Infertility?
1. Expectant management: Couples who are young with no obvious cause of infertility and the period of infertility is short may just be asked to wait for around 6 months to 1 year to try naturally. During this kind of treatment, you can undergo folliculometry i.e., regular ultrasonography to determine the exact days for timed intercourse.
2. Superovulation and Intrauterine insemination (IUI): Superovulation is the process of developing up to 2 to 3 follicles instead of just one. In those couples for whom expectant management has failed, or the duration of infertility is more or the average age of the couple is more, it's better to go ahead with superovulation and IUI. The aim here is to increase the gamete density by processing and concentrating the sperms and getting them closer to more than one egg, such that the chances of conception increase. In doing this, we also overcome any hostile cervical mucus which may be encountered by the sperms while trying naturally.
3. In Vitro Fertilization: In those who have tried 3 to 4 cycles of IUI and have not conceived, IVF is the next viable option. In most laboratories nowadays, IVF is accompanied by ICSI i.e., Intracytoplasmic Sperm Injection. During this treatment, as many eggs as possible are developed, they are retrieved under ultrasonographic guidance, the eggs are microinjected with individual sperms and embryos are thus formed. These embryos can then be transferred into the uterus of the woman. IVF usually increases the success rate of clinical pregnancy to 55 to 60% in one cycle.
4. Role of laparoscopy: If the duration of infertility is more than 3 years, it may be useful to go ahead with a Diagnostic Hysterolaparoscopy to rule out any abnormalities which have been missed on ultrasound and simpler tubal tests.
5. Role of Genetic analysis of the embryo: In a situation where even IVFs have failed without any known cause, or the mothers age is approaching 40 years or there is a suspicion of genetic abnormality, Preimplantation Genetic Testing or PGT may be advised to screen for any genetic abnormality in the embryo before transferring it into the uterus.
The Infertility and Reproductive Medicine consultant in Bangalore are highly experienced in providing solutions for male and female infertility.
Consultant - Ivf & Reproductive Medicine
Manipal Hospital, Whitefield, Bangalore
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