what is unexplained infertility?

My journey through infertility started with the diagnosis of unexplained infertility. Eventually, it changed to endometriosis. I was frustrated and confused when it appeared like no one could give me the answers I so desperately wanted. It is heartbreaking, confusing, frustrating, insert your word to receive this diagnosis. For those that may not be familiar with unexplained, this is when you have been trying to conceive without results and both the male and female have had a full infertility workup without any findings that are abnormal. So basically everything appears normal to the medical provider yet the results are indicating otherwise aka not pregnant.

I have compiled information from the American Society of Reproductive Medicine (ASRM), the American College of Obstetricians& Gynecologists (ACOG), and the American Academy of Family Physicians (AAFP).

Definition of unexplained infertility

Definitions are similar thorough out but overall this is couples who have no identified cause of infertility. It is when the basic infertility evaluation is performed, and all the tests results are normal.

Diagnosing unexplained infertility

The initial workup for unexplained infertility should include the history of menstrual history, timing and frequency of intercourse, previous use of contraception, previous pregnancies, pelvic infections, medication use, occupational exposures, substance abuse, alcohol intake, tobacco use, and previous reproductive surgery. ASRM recommends a semen analysis, ovulation testing, assessment of ovarian reserve, and imaging to assess for tubal and uterine factors.

Treatment of unexplained infertility

The general consensus is to start with empiric treatment meaning educated guesses because it does not address a specific defect or issue. Observation of ovulation with timed intercourse and lifestyle changes should be intimated. Common medications used include clomiphene citrate and letrozole with timed intercourse or intrauterine insemination (IUI). Other options include controlled ovarian hyperstimulation with IUI, and at times IVF is needed.

Key takeaways

Ensure you have had a full workup if you have any menstrual abnormalities to rule out polycystic ovarian syndrome, thyroid disease, hyperprolactinemia, and other causes. Consider having a trained healthcare provider review your menstrual history and discuss other methods used to evaluate ovulation include basal body temperature (BBT) recordings, urinary luteinizing hormone (LH) ovulation predictor kits, and mid luteal serum progesterone testing.

Make sure you feel your doctor has answered all your questions so you have clarity about your treatment or why a certain treatment is right for you. This diagnosis can be confusing and bringing a coach into your care team can help provide clarity.

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