“Unexplained” Infertility

Is it really “unexplained?”

In some ways, it’s an infertile couple’s worst nightmare. They’ve been trying to conceive, sometimes for years. They do everything right, go to a specialist to find out what to do.

And they get no answers as to why they can’t conceive!

What do you do when you know there is something wrong but you can’t get to the root cause.

According to some estimates, up to 30% of all infertility patients will never discover the reason for their inability to conceive. Test after test comes back in the normal range, a full infertility work up reveals nothing, and yet no matter how hard they try, these patients are unable to conceive.

Not only are they infertile. But their infertility is “unexplained.”

So what can you do with this sentence of “unexplained” infertility? Should you take “we don’t know” for a final answer?

Emotionally, getting this kind of diagnosis adds devastating insult to injury. It is incredibly frustrating to know you have a problem, your doctor agrees that yes you do have a problem, and yet the doctor cannot tell you what is wrong and how to fix the problem!

According to our in-house psychologist, Cheryl Zadek, the combination of helplessness, frustration, and silent guilt sends many patients with this diagnosis into anxiety and/or depression.

Sometimes, getting to that diagnosis, finding out the root causes of what is going on, requires the detective skills of Sherlock Holmes. You need to find a doctor who is willing to dig below the surface, dig deep, to get to the bottom of what is causing the problem so that you know how to overcome infertility.

The first thing you need to do is DO NOT ASSUME. Do not assume your lab results are what they are, do not assume they were read correctly, and do not assume the old results still apply today. If you came to my office telling me that you had “unexplained” infertility, I would start by combing through your medical records with a magnifying glass, looking for inconsistencies, mistakes, gaps, lab errors.

I have found many instances where general doctors, and even sometimes specialists, have not bothered to read the lab results to get the results! I have found others where the wrong tests had been administered, the tests were processed in a faulty way by a lab. Or even where the diagnosis was just flat wrong for reasons I cannot figure out.

I would start with the primary causes of infertility, but I wouldn’t end there. I have had cases of infertility caused by obscure genetic defects, syndromes so rare that they weren’t even named. I’ve discovered cases of infertility caused by tuberculosis infecting the uterus instead of the lungs. I have discovered abnormalities using experimental surgery where the causes of infertility were invisible to the surgeon’s naked eye.

I work backwards, from the most obvious causes of infertility to the most obscure. And you may have a compound reason for your infertility, where borderline normal results on two or three different factors combine to create a situation where you and your partner together are infertile, though all of your tests are seemingly “normal.”

In short, I refuse to accept that infertility is “unexplained.” It may take me a lot of doing, a lot of detective work, and a lot of digging into your medical past, but I never give up until I figure out what is going on. Because then I know what I need to do to fix it.

My field, reproductive endocrinology, is one of the most exciting, dynamic fields in all of medicine. We are constantly discovering new causes of infertility, new treatments, and new tests. In all of the detective work we do to develop a diagnosis, I am constantly aware that new tests and treatments give us more tools all the time to discover problems in the reproductive process.

Even if I cannot immediately discover the reasons you cannot conceive, we can get right to work on treatments that many of our patients use no matter what their diagnosis. IUI (insemination) is a low intensity intervention that many patients who have more time use, and if I am certain your tubes are not blocked and the sperm are healthy enough to make it through the cervix and to the eggs, we will go ahead even as I keep working on a diagnosis.

In addition, IVF (in vitro fertilization) is a successful, fast way to achieve pregnancy, and used by patients with any number of fertility issues. If time is of the essence, and I have determined that your uterus is normal and can achieve a normal implantation of an embryo, we can go ahead with IVF as well. An accurate diagnosis is vital to delivering the most effective care. But even in the absence of a full picture, I can do a huge amount to get you over the hurdles that many couples face in their path to parenthood.