Experiencing unexplained infertility doesn't mean you can't have a child of your own. Learn about how to get a diagnosis of unexplained infertility, and what treatment options are available.

At what point is it a good idea to seek help conceiving? Can couples experiencing infertility have children of their own? What is the best way to deal with the situation?

Some couples or individuals are unable to conceive. According to the World Health Organization, anyone who has not yet conceived a child after 12 months of unprotected sexual intercourse is considered infertile. In women over the age of 35, infertility is mentioned as early as six months. Often, fertility specialists can find out the cause of the fertility problem with different tests and examinations. However, sometimes they do not identify any physical peculiarities. Such cases are referred to as unexplained or idiopathic infertility.

Experiencing unexplained infertility doesn't mean a couple can't have a child of their own. In this article, you will find out what the possible reasons for your unfulfilled desire to have children could be, how to get a diagnosis of unexplained infertility, and what treatment options are available.

What is unexplained infertility?

Unexplained infertility is when the cause of the unsuccessful attempt to conceive cannot be found by specialists. This is believed to be the case for around 15 percent of infertility cases.

If you haven't been trying as long as described above, we recommend that you identify the day of ovulation and try to have regular sexual intercourse during the most fertile days (a period of six days up to and including ovulation). Learning how to calculate your ovulation is a simple step that you can take to understand your cycle.

Women who have reached the age of 40 and anyone who is aware that they may have fertility problems should seek medical advice sooner.

Infertility, sterility, and impotence

There are various terms that refer to difficulty conceiving: infertility, sterility and impotence. Although these terms are often used synonymously, they mean different things. It is important to differentiate between them and understand them. Sterility refers to the permanent inability to have a child, whereas infertility is the inability to have a child after a designated period of time. Both words can refer to men and women.

Contrary to popular belief, male-factor infertility is responsible for or contributes to 50% of infertility cases. Female infertility is when a woman cannot become pregnant or if she becomes pregnant but experiences miscarriage. Impotence, on the other hand, refers to the inability of some men to maintain an erection; this is often accompanied by an inability to have children.

By understanding the terminology, it may be easier to address your situation and evaluate your options. Always ask professionals if you are unsure how they use the terms.

Diagnosis and causes of unexplained infertility

Unexplained infertility is not a diagnosis per se as the cause of the problem remains unknown. One therefore speaks of a diagnosis of exclusion, which means that all possible diagnostic procedures have been carried out, but a disease could not be identified.

Especially in couples where the woman is over 35 and the man over 40, it can take longer to conceive a child. The quality of the sex cells (eggs and sperm) decreases due to natural, physical aging processes. However, there could also be diseases or disorders of the sexual organs that explain the unsuccessful attempts.

Before your doctor speaks of unexplained infertility, they will use fertility tests to assess whether there are abnormalities, such as

  • Hormonal Imbalances. Women with hormonal imbalances may have anovulatory cycles (menstrual cycles in which ovulation occurs irregularly or not at all). Many women do not notice the anovulation because they still get their menstrual period. Hormone imbalances can also impact egg quality and prevent the fertilised egg cell from implanting in the lining of the uterus. A medical specialist will carry out blood tests to check the levels of the relevant hormones, such as follicle-stimulating hormone (FSH) or prolactin. Hormonal imbalances can be triggered by premature menopause, pituitary disorders, polycystic ovary syndrome (PCOS), hyperprolactinemia, thyroid disease or functional hypothalamic amenorrhea.
  • Blocked fallopian tubes. In order for a sperm cell to fertilise the egg cell, the fallopian tubes must be free. Infections, previous ectopic pregnancies, surgical scar tissue, and even endometriosis can cause blocked fallopian tubes. There are different procedures for testing whether the tubes are open. One of them is the uterine X-ray, called a hysterosalpingogram. In this process, a catheter is inserted into the uterine cavity via the vagina and a liquid (called contrast medium) is then distributed in it. Contrast medium makes it possible to visualise certain parts of the body that cannot be seen with normal X-rays. Another option is a laparoscopy. The procedure takes place under general anaesthesia. Before a complex operation is ordered, however, it should definitely be ruled out that the reproductive limitation is not caused by your partner.
  • Problems of the uterus. The cause of infertility can also come from the uterine cavity or cervix. This may include irregular formations, blockages, pelvic adhesions, cervical mucus that is inhospitable to sperm, certain types of cancers, and benign polyps or cysts that prevent implantation. The condition of the uterus is usually checked using a vaginal ultrasound, hysterosalpingography, or a hysteroscopy.
  • Impaired semen parameters. A semen analysis may be carried out to assess whether the number of sperm (sperm count), sperm motility (sperm movement) and sperm shape (morphology) may be impaired. For this, the man gives a sperm sample, which is analysed in the laboratory. Sperm production can be affected by an illness such as kidney failure or diabetes, infections, undescended testicles or genetic defects. Varicoceles, i.e. swollen veins in the scrotum, blocked spermatic ducts, retrograde ejaculations (where sperm flows into the bladder), hormonal imbalances, certain medications or antibodies that attack the sperm can also cause male infertility.

In our separate articles, we go into more detail about female infertility and male infertility.

Treatment options for unexplained infertility

There are a number of infertility treatment options at fertility centers:

  • Hormone treatment. In the case of hormonal disorders in women, ovarian stimulation is used to boost egg cell production in the ovaries, which ideally means that several follicles (egg sacs) mature per cycle. The process comes with risks such as the rare ovarian hyperstimulation syndrome (OHSS). To ensure safety, it is important to undergo regular gynecological examinations.

    Hormone treatments, for example with gonadotropin-releasing hormone (GnRH) or choriogonadotropin (hCG), are also carried out in the case of unexplained male infertility. There are studies reporting a positive effect on spermatogenesis with FSH administration. However, it must be taken into account that the current study situation is very limited and further investigations are necessary in order to be able to make a definitive statement on the effect of FSH.
  • Surgery. Various surgeries, such as laparoscopy or testicular biopsy, may be used to investigate potential causes of infertility or treat associated problems.

In some cases, your fertility specialist may recommend various methods of assisted reproduction, including

  • Intrauterine insemination (IUI). IUI is mainly used when there are problems with the male partner’s fertility. The man gives a sample of his ejaculate to the fertility center, which is then analysed for suitable sperm. These are placed directly into the uterus with a thin tube on the day of ovulation. In this way, the sperm have a simplified route to the egg cell. It is not uncommon for women to receive hormone treatment at the same time.
  • In vitro fertilisation (IVF).
  • Intracytoplasmic sperm injection (ICSI).

Since IVF and ICSI are more time-consuming and expensive than IUI, they are only used if the IUI was unsuccessful, if there are severe tubal adhesions or if the sperm quality is extremely poor.

How to increase your fertility

Before your appointment at the fertility clinic or treatment, there are already a number of things you can do together as a couple for your fertility:

  • Integrate many balanced and healthy recipes into your everyday life
  • Reduce as many stress factors as possible
  • Get enough sleep
  • Try to maintain a BMI between 18.5–25
  • Avoid alcohol, tobacco and drugs
  • Include enough (but not too much) exercise in your everyday life

Get support for stress

Unwanted childlessness can be extremely stressful—not only for oneself, but also for a partnership. The frustration is even greater when the diagnostic methods cannot provide any information about the causes. This can trigger a range of emotions, from anger and sadness, to guilt and shame. Here are some tips that we hope will help you deal with your situation:

  • Allow yourself to cry and be angry. Don't try to suppress your feelings.
  • Allow your partner to feel or deal with it differently.
  • Discuss together how you would like to be supported. Clear and open communication about your own needs is important so that the other person can act in accordance with them.
  • Get more information. The uncertainty is arguably one of the worst aspects of unexplained infertility. Educating yourself about the many options for fertility treatments may help you deal with uncertainties.
  • Find like-minded people in self-help groups or online communities who are in the same or a similar situation as you.
  • If you feel the need for professional support, you can also seek psychological support for this difficult time. There are coaches and therapists who specialize in supporting infertile couples. For example, it has been shown that psychotherapy or infertility counseling can help to reduce the stress associated with infertility and treatment.
  • Don't forget: statistics are important and good, but be careful when interpreting certain numbers or percentages. Each case is individual, and with the measures above you have the opportunity to increase your chances of pregnancy.

Takeaway

Before you can be diagnosed with unexplained infertility, hormonal disorders, diseases and problems with the sexual organs must be ruled out. It is completely understandable that this process triggers many negative emotions. Get the support you need: talk openly with your partner or seek psychological counselling if you need it.

Unexplained infertility is a very stressful situation for affected couples. However, it is positive in that you have not been identified as having a medical problem or an illness. At this point, there are a variety of treatments that you may want to consider, including assisted reproductive technologies. You can also try making some lifestyle changes. When choosing fertility treatment, you will consider various factors with your healthcare provider, such as the test results, your general family planning and desired number of children.

Our empathetic team at Cada will support you on your fertility journey. Contact us today for a free consultation.