Unexplained Infertility: Causes, Diagnosis & Treatment Options

Have you ever wondered why the doctor is unable to tell you the exact reason you have not conceived after doing some tests? You hoped to get answers and explanations to your numerous questions about pregnancy, but no suitable reason was given. That can be frustrating and overwhelming. It is not right to keep going without answers. Here, I would explain why sometimes it is hard to say the exact reason why you are not pregnant despite different tests.

Sometimes, women or couples experience difficulty getting pregnant for no apparent medical reason. This state is called unexplained infertility. In this case, there are no abnormalities as the woman is ovulating regularly with at least one open fallopian tube, and the man has normal sperm with no obvious defect. It occurs in about 30% of couples worldwide. For one to have the diagnosis of unexplained infertility, it means the woman or couple have gone through a fertility evaluation.

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What are the causes of unexplained infertility

What are the causes of unexplained infertility?

As I said, there is no obvious reason; if a reason exists, health providers can't measure or test for it. There are some possible reasons for unexplained infertility.

• An undiagnosed underlying health condition: Many things affect fertility, and no one is entirely sure how every condition affects fertility. The body is a beautiful, complex entity with interconnected organs and systems. Researchers continually study how our bodies work to learn more about how they work. For example, celiac disease  (gluten allergy), thyroid disease and diabetes are now seen to contribute to infertility.
• Poorly timed sex: Sometimes, the frequency or timing of sex might not match up with your ovulation. Therefore, it is recommended to have sex every two to three days.
• Anatomical abnormalities: Researchers previously said that a retroverted uterus( titled womb) might cause unexplained infertility. It found that it was unlikely; however, there may be a defect in the mouth of the fallopian tube that prevented it from picking up eggs despite not having block tubes.
• Endometriosis: This is the presence of uterus lining outside the uterus. It causes severe abdominal pain during the period and excessive menstrual bleeding. It is diagnosed by surgery. Sometimes, there might be a mild case of endometriosis with no symptoms at all. This mild endometriosis could contribute to infertility.
• Cervical mucus: Cervical mucus helps sperm swim up to the egg during ovulation, then fertilise the egg for pregnancy. Inadequate cervical mucus meaning either thick cervical mucus or the presence of foreign ingredients in the mucus, will not assist sperm in travelling through the cervix or even entering the vagina. This doesn't help pregnancy as well.
• Uterus lining: After an egg gets fertilised by a sperm, it needs to be attached and grow in the womb during the pregnancy period. For this to occur successfully, the womb's lining should be thick. Luteal phase defect is when the womb’s lining isn't thick or prepared for the fertilised egg. It is usually associated with insufficient progesterone production. Unfortunately, if a fertilised egg can't get implanted in the womb, conception might not happen.
• Sperm quality: The quality of sperm can affect conception. A semen analysis can reveal most issues;  however, some are issues associated with unexplained infertility.
• Egg quality: The quality of an egg can also contribute to unexplained infertility.
• Lifestyle practices such as unhealthy diet, stress, smoking, alcohol, recreational drugs and obesity could contribute to unexplained infertility.

These causes are not exhaustive, as research is conducted daily. Some common questions about what causes infertility exist. I will discuss some of these questions and their answers.

1. Does hitting the cervix cause infertility?

Fortunately, hitting the cervix during intercourse is not likely to lead to infertility. It may cause some temporary bruising that should heal on its own. The discomfort from bruising might make sex less appealing, which could impede conception. However, if you experience severe pain during intercourse or notice bleeding, it’s crucial to consult a gynaecologist.

2. Can drugs cause infertility in females?

Depending on the type of drugs taken and how long, some drugs can cause infertility and even harm the unborn child. For example, recreational drugs like cannabis, cocaine, and heroin can reduce fertility by affecting ovulation. Chemotherapy may also affect fertility by preventing the ovaries from releasing eggs. It is vital to discuss with your doctor if you are going to have chemotherapy and you want to conceive. There is an option to preserve fertility before starting chemotherapy, like freezing your eggs. Also, antipsychotic drugs such as haloperidol and chlorpromazine might cause a hormonal imbalance, which can cause infertility.

3. Can steroids cause infertility in females?

Prolonged and elevated use of steroids, especially anabolic-androgenic steroids, can disrupt the endocrine system in women by suppressing hormones essential for ovulation, such as luteinising hormone (LH) and follicle-stimulating hormone (FSH). This hormonal imbalance can lead to irregular menstrual cycles or absence of ovulation, making it more difficult to achieve pregnancy.

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Can steroids cause infertility in females?

Diagnosis of Unexplained infertility

To diagnose unexplained infertility, it is essential to perform a standard fertility evaluation.

For male

Male fertility depends on the testicles producing a sufficient quantity of healthy sperm. For conception to occur, the sperm must be ejaculated from the penis into the vagina, where it needs to reach the egg. Examinations and tests for male infertility aim to determine if there are addressable issues with any of these stages. You might undergo a physical exam that involves an assessment of your genital area. Specific tests for infertility could consist of the following:

• Hormone evaluation. A blood test may be done to assess your testosterone levels and other male hormones.
• Semen evaluation: Your medical team might request one or several samples of your semen. Typically, you obtain semen by masturbating or by pausing during intercourse to ejaculate into a sterile container—afterwards, a laboratory analysis of your semen sample. In certain instances, urine might be examined to determine if it contains sperm.
• Genetic testing can be conducted to determine if a genetic abnormality is responsible for infertility.
• Imaging: In certain situations, your medical team might suggest tests that create images of your body's interior. For instance, an ultrasound can help identify issues in the scrotum, the glands that produce fluids forming semen, or the duct responsible for transporting sperm from the testicles. A brain MRI can detect non-cancerous tumours in the pituitary gland. These tumours may lead the gland to overproduce the hormone prolactin, which could decrease or completely halt sperm production.

For female

Women’s fertility depends on the ovaries producing healthy eggs. The reproductive system must allow an egg to move into the fallopian tubes and combine with sperm. After fertilisation, the egg must move to the uterus and adhere to the uterine lining. Assessments for female infertility aim to identify issues with any of these processes.

• Ovulation test: A blood test evaluates hormone levels to determine if ovulation occurs.
• Hysterosalpingography evaluates the state of the uterus and fallopian tubes and identifies obstructions or other issues. A special dye is introduced into the uterus, followed by an X-ray examination.
• Ovarian reserve test: This assists your healthcare team in determining the number of eggs available for ovulation. The process typically starts with hormone testing at the beginning of the menstrual cycle.
• Pelvic ultrasound is used to detect conditions affecting the uterus or ovaries. Occasionally, a procedure known as a saline infusion sonogram is performed to visualise details within the uterus that may not be visible on a standard ultrasound. The saline infusion test is also referred to as a sonohysterogram.
• Genetic carrier screening: a genetic test that tells you if you carry a gene for certain disorders that could prevent pregnancy.
• Laparoscopy involves a cut below the navel through which a thin viewing device with a camera is inserted to inspect the fallopian tubes, ovaries, and uterus. This procedure can detect endometriosis, scarring, and blockages and treat conditions like fibroids and endometriosis tissue.

What to do next?

If your doctor performed a complete fertility evaluation and still can't find a cause, it might be considered unexplained infertility.

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What to do next?

Is it possible to get pregnant with unexplained infertility?

Hearing that you have unexplained infertility might be devastating, but this diagnosis doesn't mean you should give up on your hope of having a baby. Do you know that as high as 92% of couples with unexplained infertility eventually had a child after treatment? So please don't give up.

What are the treatments for unexplained infertility?

After the diagnosis, you would be referred to a reproductive endocrinologist. Your treatment will be based on various factors, including your age. Here is a list of likely treatments

Change in lifestyles: Different factors can affect fertility, and it is good to practise healthy lifestyles to increase your chances of pregnancy. Here is a list of healthy lifestyles you should practice

• Eating a balanced diet.
• Maintain a healthy weight.
• Reduce sedentary lifestyle, and exercise 30 minutes at least thrice a week.
• Avoid smoking, excessive alcohol intake and using recreational drugs

Medications: The use of fertility drugs such as clomiphene citrate will help with ovulation; for example, undergoing treatment with Clomid pills for a duration of 3 to 6 months, according to your fertility specialist's recommendation, could enhance fertility by up to twice as much as without any treatment. Be sure to speak with your doctor to learn the most suitable drug and its side effects. Sometimes, fertility drugs can be used alone or in addition to ART.

Intrauterine insemination(IUI): Intrauterine insemination(IUI) is where a doctor inserts donor or partner sperm that has been washed and concentrated into the womb during ovulation via vaginal using a thin tube.

Assisted reproductive technology (ART) encompasses any fertility treatment that involves the manipulation of eggs and sperm. The most widely used ART method is in vitro fertilisation (IVF). Key steps involved in an IVF cycle include: Fertility medications are used to stimulate the ovaries to produce eggs. Mature eggs are removed from the ovaries. The eggs are then combined with sperm in a laboratory dish for fertilisation. The resulting fertilised eggs, known as embryos, are transferred into the womb. Additionally, embryos can be frozen for future use.

What do I do while I wait to conceive?

Waiting to get pregnant can be challenging; it comes with a lot of emotional ups and downs. Some people achieve conception after unexplained infertility later than others; during the waiting period, you could consider some of these things.

• Keep eating healthy
• Keep exercising
• When you feel overwhelmed, take a break and relax. You could meditate, go to the spa, stroll on the beach, or talk to your loved one.
• Seek support from family, friends or a therapist.
• Treat any sexually transmitted infection(STI) you have as soon as possible.
• Avoid alcohol, smoking and recreational drugs.
• Keep learning about unexplained infertility and a suitable treatment for you.
• Stay dehydrated, take vitamins, especially the recommended dose of folic acid.
• Keep having a lot of sex.
• Avoid stress.

Remember that your journey is unique. Do not compare yourself with others. Be kind to yourself and focus on your overall health and well-being.