Unexplained Infertility

Unexplained Infertility

Unexplained Infertility

Why Normal Test Results Don’t Always Equal a Clear Diagnosis

When couples struggle to conceive, we often first seek answers through fertility testing. However, receiving normal results can feel both relieving and frustrating. Many individuals wrongly assume that normal test results mean there is nothing wrong, overlooking the complexities of infertility. In this blog post, we will explore unexplained infertility, and why normal test results don’t always provide a clear diagnosis – and what steps to take next.

The Complexity of Infertility

Various factors can make it difficult to get pregnant, making infertility a complex issue. While test results may indicate that certain aspects of fertility are functioning normally, they do not guarantee that there aren’t other underlying issues.

Infertility can stem from a combination of factors, including hormonal imbalances, ovulation disorders, sperm abnormalities, or structural issues in the reproductive system. In fact, in more than half of couples undergoing an infertility evaluation, a clear, singular answer of what is causing the difficulty is not found.

Consider this example: an imaging test may determine that a patient’s fallopian tubes are open, which sounds encouraging. However, there is not a test yet that determines how those tubes actually function, since millions of microscopic muscles are needed within one functioning tube to move an egg into the uterus.

Similarly, a sperm count can verify that there are a multiple number of good appearing sperm. However, there is not a test yet to determine how the sperm interacts with an egg on a chemical and microscopic level.

There are no tests invented yet to determine how the embryo interacts with the uterine side wall, or how the genetics within an embryo divide within a woman’s body, and the list goes on. Science has made remarkable strides, but researchers still have much to discover.

Male Factor Infertility

Normal test results for one partner (typically the female) do not rule out the possibility of male factor infertility. Male fertility issues, such as low sperm count, poor sperm motility, or abnormal morphology, can contribute to difficulties conceiving. Therefore, both partners should undergo comprehensive fertility testing to ensure a thorough evaluation.

Unexplained Infertility

In some cases, couples receive the frustrating diagnosis of “unexplained infertility,” despite normal test results. This diagnosis occurs when no specific cause can be identified through standard testing. It doesn’t mean that there isn’t an issue; rather, it indicates that the exact cause remains unknown. Unexplained infertility accounts for a significant percentage of infertility cases, leaving couples searching for answers and potential treatment options.

Specialized Testing and Evaluation

If you’ve received normal test results but are still struggling to conceive, it’s essential to consult with a reproductive endocrinology and infertility specialist. These fertility experts can provide a more in-depth evaluation, including specialized testing that goes beyond the basics. Advanced tests, such as genetic screening, hysteroscopy, and more detailed hormone analysis, may uncover underlying issues that standard tests might miss.

Lifestyle and Environmental Factors

While testing can provide valuable insights, it’s essential to consider other factors that may impact fertility. Lifestyle choices, such as smoking, excessive alcohol consumption, poor diet, stress, and exposure to environmental toxins, can affect fertility even when test results appear normal. Addressing these factors and adopting a healthy lifestyle can improve your chances of conceiving.


When a clear answer cannot be identified, the two most utilized interventions are intrauterine insemination (IUI) and in vitro fertilization (IVF). Ovulation induction IUI attempts to strengthen a woman’s natural cycle, boosting each portion of the process. However, if a significant problem exists, IUI is not capable of correcting it in the majority of patients.

IVF “changes the game” for many couples, in the sense that it bypasses several major processes that could be suboptimal in function. For example, if there is a problem with tubal function, IVF gets around the tubes. If there is a problem with egg and sperm interaction, the process of IVF injects the sperm directly into the egg and bypasses this interaction.


A fertility evaluation helps to determine obvious, high-level problems on the front end such as blocked tubes, low sperm count, and more. However, in the vast majority of patients, the causes of infertility are more subtle and a clear answer is not found.

Consulting with a fertility specialist, exploring specialized testing, and considering assisted reproductive technology such as IUI and IVF can help you navigate the path towards parenthood with a more comprehensive approach. Remember, the journey to building a family often requires persistence, support, and expert guidance.

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