Unexplained Infertility: helping you understand your options

Infertility is an inability to become pregnant within a year of regular trying to conceive. Around 15%-30% of couples have unexplained infertility. In these couples, all routine tests are normal. Doctors are unable to find a cause for infertility.

Inability to become pregnant can cause a lot of anxiety in couples. The good news is that 8 in 10 couples will achieve a pregnancy without any treatment within 3 years. If you know what causes a delay in getting pregnant, it can help to overcome the anxiety. It is also helpful to be aware of all treatment options so that you can make an informed choice.

I have a story to share which will give you hope if you are presently unable to become pregnant.

In my practise as an Obstetrician, I remember seeing a lady in my clinic. She was in her early thirties. She came for a consultation as she was having tummy pains.

As I was talking to her, trying to find out what was causing the pain, I asked her when she had her last period.

She replied that it was two months back. I asked her if she had done a pregnancy test.

She said there was no chance of pregnancy. I assumed that this was because she was not currently with her husband and I left it at that.

I examined her and then did an ultrasound scan. I could see a baby in her womb, around 8 weeks old with a heart beat.

I turned the scanner towards her and showed it to her.

I can never forget the expression on her face. It was disbelief, shock, happiness and so much more.

She told me her story.

She had been married for around 6-7 years. She had been for many tests as she was unable to get pregnant. All the tests were normal.

She had 5 cycles of IVF, all of which failed.

She had given up hope, resigning to the fact that she was not destined to have children.

This was a natural pregnancy in a lady who had completely lost hope that she would ever become pregnant.

With this hopeful streak, let’s look into the journey ahead if you have been told that you have unexplained infertility.

The first step

If you are unable to conceive after a year you should see your GP.

Your GP would ask some relevant questions, perform an examination and then refer to a specialist.

If you have any issues that may impact fertility, like if the female partner is above 35 years of age, or either partner has had cancer treatment, you should see your GP after 6 months of trying to conceive.

Causes of infertility

  • Ovulation problems may be because of polycystic ovaries, or reduced eggs following cancer treatment or surgery.
  • Blocked fallopian tube preventing the egg from meeting the sperm. This could be due to endometriosis, pelvic inflammatory disease, or previous surgery, causing scarring of the tube.
  • Abnormalities of the womb like fibroids, or congenital conditions of the uterus like a double uterus or a septate uterus.
  • Problems with sperm production, the function of sperm, or the delivery of sperm.
Tests for infertility

Routine tests are done for all couples with infertility.

  • Blood test for the hormone progesterone for women to see if you are ovulating.
  • Swab test from the cervix (neck of the womb), or a urine test, looks for chlamydia infection.
  • Ultrasound scan to make sure the womb, ovaries, and fallopian tubes are normal. Sometimes a small amount of liquid may be pushed up the womb’s neck to see if the fallopian tubes are open. If the tubes seem blocked, they may do further tests like a laparoscopy.
  • Semen analysis for the male partner.
Unexplained infertility

If there is nothing suggestive of causing infertility in history or examination, and all of the above tests come back as normal, you call it unexplained infertility.

In many cases, you will go on to have a spontaneous pregnancy, without any treatment or help. You need to be aware that chances of natural pregnancy are increased in younger couples with a short duration of infertility.

High rate of natural pregnancy 

 If you and your doctor decide to wait and watch and not start any treatment:

  • 13%-15% couples will achieve a pregnancy in 1 year.
  • 35% will have a spontaneous pregnancy in 2 years.
  • 80% will have a pregnancy in 3 years.
Younger couples have a higher success rate.

However, chances of pregnancy decrease with infertility of more than 3 years duration and in women over the age of 30 years.

Treatment options

  • According to NICE, a wait and watch approach is preferred in younger couples with less than 3 years of infertility. Couples should be aware of fertile period using a calendar method or BBT.
  • Clomiphene, or Gonadotrophins, medications used to increase the production of eggs in the female, do not increase pregnancy chances in unexplained infertility.
  • IUI (Intrauterine insemination) involves placing washed sperms in the womb through a plastic tube. If IUI cycles do not succeed, couples are then offered IVF.
Some doctors and couples may decide to go for IVF straight away.

There is no standardized approach. The above is an update based on numerous studies.

Different centres may follow other protocols and individualized approach.

  • IVF (In Vitro Fertilization) with or without ICSI (Intracytoplasmic sperm injection) is the most successful treatment of unexplained infertility. If infertility duration is longer than 3 years, and the female partner is above 35, IVF is preferred over expectant management.
You should consider the side effects of drugs in IVF, along with the cost. There is a chance of multiple pregnancies with IVF with the associated risks.

  • Immune therapy with intravenous immunoglobulin is tried in some centres when repeated attempts at IVF fail. However, this does not improve the live birth rate after IVF.
Lifestyle changes

While waiting for a natural pregnancy, or IVF, natural steps may increase the chances of conception.

Alcohol and smoking has a negative effect on fertility.

  • Reduce caffeine intake to 2 cups of coffee.
  • Women should maintain a normal BMI. 
  • Men should avoid hot saunas and wear loose underwear, as it may affect sperm production.
Support systems

Waiting for a pregnancy can be stressful and puts a strain on the relationship between partners. Family and friends can help. Support groups can provide valuable support and advice.

Dua, or supplication, is the best way to reach out to our Creator.

This is the dua of Zakarriya (peace be upon him).

If you have been through IVF and not conceived, you may want to look into adoption. There are many Islamic rulings regarding adoption and you may need to consult a religious scholar.

I hope I have provided some clarity on what to expect.

Stay positive, make lots of dua and know with certainty that Allah swt will give you what is best for you at a time appointed by Him.