Infertility is diagnosed when women under 35 cannot get pregnant despite having unprotected sex for one year, and women aged 35 and older for six months. Once infertility is diagnosed, some examinations and tests are done on both the man and the woman to find out the cause of infertility. However, many infertile couples have no reason for infertility despite having all the necessary tests. In these cases, infertility is referred to as unexplained. About 20% of couples experiencing infertility are diagnosed with unexplained infertility.
The exact causes of unexplained infertility are unknown or current fertility tests may not be sufficient to identify ‘unexplained’ causes of unexplained infertility. More likely causes of unexplained infertility could be:
- Ovulation disorders
- Poor egg quality
- Inadequate frequency of intercourse or timed intercourse to coincide with ovulation
Treatment options for couples unexplained infertility
Waiting and Lifestyle changes.
If the woman is under 35 and has a good ovarian reserve, the couple can expect to conceive spontaneously within 3 years. Because 60% of unexplained infertile couples can conceive spontaneously within 3 years. During this waiting period, patients should make some lifestyle changes such as being at a healthy weight, reducing stress, quitting smoking, eating a healthy and nutritious diet, exercising regularly, taking supplements and antioxidants. If the egg reserve is good, and the woman’s age is below 35, the waiting option would be the first choice. If the patient does not want to wait,or she is over 35 years the treatment plan can be changed.
Timed intercourse
Timed intercourse determines when to have intercourse to increase the chances of pregnancy. It is a low-risk, inexpensive technique. It involves monitoring the ovarian cycle through ultrasound and hormone testing. Monitoring helps determine the day of ovulation when fertility potential is high.
IUI
If the woman still cannot get pregnant despite waiting for a years and having intercourse on time, the next treatment step may be IUI. Egg reserve should be evaluated before IUI starts, if egg reserve is low, IUI may be bypassed and IVF may be preferred. The chance of success for IUI is approximately 15-20% in each attempt. After 2-3 unsuccessful IUI attempts, IVF treatment can be started.
IVF
IVF is more effective than the treatments described above, with a higher chance of success but it is more expensive than treatment options above. Therefore, if the age of the woman is under 35 and if the egg reserve is good, the treatment methods described above are prioritized. However, if the woman is older than 35, has decreased ovarian reserve, or is at risk of early menopause, direct in vitro fertilization treatment is started by skipping the other less effective treatment options described above.
