Management of Unexplained Infertility

The term ‘thorough’ for investigating infertility in a couple is subjective. In any case, it should cover the main causes of infertility. Of the 100 couples who will try to achieve pregnancy, 85 to 90% will succeed within 12 months. In the remaining 10-15%, the diagnosis of infertility is made and testing begins, although almost half of these couples will achieve conception within the next 12 months. Testing of the infertile couple in a 75% rate will reveal one of the following three causes: 1) Ovulation disorder, 2) sperm disorder and 3) tubal patency disorder. In 8% the cause is endometriosis, in 2% various factors such as immunological, endometrial adhesions or cervical factor. In the remaining 15% no cause is found and we have unexplained infertility.

The management of unexplained infertility begins with lifestyle changes for the couple. These include quitting smoking, limiting coffee consumption to two cups per day and alcohol to four drinks per week. The woman should also achieve a body weight that corresponds to a Body Mass Index (BMI) between 20 and 28. For example, for a woman who is 1.60m tall, the ideal weight is between 51 and 69 kg, for a woman who is 1.65m tall, between 54.5 and 73.5 kg, and for a woman who is 1.70m tall, between 57.8 and 78 kg. These lifestyle changes mainly concern the woman, but we should encourage the man to adopt them as well, on the one hand for the general benefit to his health, but mainly because it provides support for the woman to achieve her goals more easily.

From there, management is individualized. In women up to 32 years of age, with normal ovarian reserves, studies have shown that waiting 6 months, giving advice for targeted contacts on fertile days, has the same results as insemination after ovarian stimulation. After this period or earlier for older women, we will proceed to the Assisted Reproduction procedures starting with the insemination mentioned earlier. This is a simple, painless, low-cost procedure, which can be done either in a natural cycle, that is, with the egg that is produced each month by one of the two ovaries on its own, or after ovarian stimulation with pills or injections. It does not make sense to perform more than 6 insemination cycles, as the highest success rates are achieved within 3 to 4 attempts. The average success rate, regardless of the woman’s age and the cause of infertility, is 25% after 3 to 4 attempts. This means that 1 in 4 couples will avoid IVF, which is the next step.

The peculiarity in the management of unexplained infertility has to do with the uncertainty that the lack of finding a cause causes in the couple. While in cases where we have a cause we lead the couple to specific choices, in unexplained infertility we must create a plan individually and in collaboration with the couple. This is why different things are done in similar cases.

This article was published in “MARIE CLAIRE” magazine