Unexplained Infertility: What Comes Next?

unexplained infertility

Unexplained Infertility: What Comes Next?

Couples trying to get an infertility diagnosis are often frustrated and dismayed when they hear the results are, “unexplained infertility.” Don’t get too discouraged, however, because the diagnosis should inspire hope.

Studies have shown that as many as 43% of couples told they have unexplained infertility get pregnant on their own without fertility treatments, and others experience pregnancy and a live birth with the assistance of further testing, accurate diagnosis, and a personalized fertility treatment plan.

There is Hope in an Unexplained Fertility Diagnosis

An unexplained infertility (UI) diagnosis is not at all the “end-of-the-road” it may sound like it is. The term actually means a whole lot of great stuff is happening that supports future fertility.

UI is diagnosed after the first round of infertility diagnostic tests have been performed and means that:

  • You have a normal menstrual cycle and are ovulating regularly
  • Your egg stores are in the normal range for your age (evaluated via ovarian reserve testing)
  • Your partner’s sperm seem healthy, are abundant, and swim like champs
  • There aren’t any visible blocks in your fallopian tubes (determined after your hysterosalpingogram)
  • The uterus looks free of anatomical abnormalities that might compromise implantation or the development of a full-term baby (assessed with a hysteroscopy)

That is all great news because they mean the basic infrastructure for a healthy fertility future are in place. The next step is making sure you are working with a fertility specialist who has great success rates in the face of an UI diagnoses.

If your OB/GYN or a fertility specialist hasn’t yet completed all of the above testing and analysis, you have an incomplete diagnosis and there is no way to say if the final answer is UI just yet.

It’s Time for a Deeper Dive Into Fertility Testing

Once the first round of diagnostic tests are complete, and with healthy results (yay, you!), it is time to take a deeper dive. Now, your fertility specialist will want to evaluate other potential causes of infertility.

Who did the semen analysis?

If your partner’s general physician and lab performed the analysis, it’s worth getting a second opinion from a fertility specialist who works with lab tech specifically trained to evaluate sperm in a more detailed way than the typical lab tech.

It is not uncommon for our lab specialists to find issues with sperm that were missed in a general review by a lab. Sperm analysis is affordable, and it might be something that sperm washing, intrauterine insemination (IUI), or the use of donor sperm can take care of without any more invasive testing or treatments.

Genetic testing

We feel preconception genetic screening should be included in any physician’s “first-round” fertility testing. While healthy egg stores are certainly good news, there is no way to test for egg quality just yet – and egg quality is essential to the conception and development of a healthy baby.

If a woman tests positive for chromosomal or genetic abnormalities, we can discuss other options, which may include IVF and selected embryo transfer based on the results of preimplantation genetic testing (PGT).


This is another procedure that is considered part of the initial fertility screening at some centers, or is only performed after a UI diagnosis at others. Using laparoscopy, we can get a closer look at the reproductive organs, looking most specifically for evidence of endometriosis.

While most women with more moderate- to severe endometriosis, and the most likely to experience endometriosis-related infertility – already know they have it, others have mild or atypical symptoms and we may learn endometriosis is a factor in their struggle to conceive.

Underlying health conditions

Some underlying health conditions affect fertility for varying reasons, often related to hyper-inflammation or immune system responses. Examples include:

  • Celiac disease
  • Rheumatoid arthritis
  • Diabetes
  • Certain autoimmune disorders
  • Thyroid disorders

We’ll work through symptoms, signs, and your medical histories to see if you may have a yet-to-be-diagnosed condition that is negatively impacting fertility.

Your body’s reaction to sperm, a fertilized egg, or the embryo

Immunological fertility treatments are one of the new frontiers of reproductive medicine. For some perfectly healthy couples, immune systems see the sperm, fertilized egg, or embryo as invaders and attack them accordingly. Fortunately, there are treatments that are gaining attention in repressing the female immune system response until the embryo is firmly established and the body has accepted it as its own.

These are some of the most common reasons why you may not be getting pregnant when everything else seems healthy and normal. Choosing the right fertility center, one with specialists who tackle a challenge and are willing to stick with it to eliminate all of the possibilities is key to your fertility success.

Schedule an appointment with us here at the Virginia Fertility & IVF to start explaining your unexplained infertility.

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