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Unexplained infertility is a frustrating diagnosis. It is also a common one. Approximately one in ten fertility challenged couples will be told there is no explanation for why they can’t conceive.

But the condition does not, however, mean that you have no options. There is always a reason for hope.

Depending on your age and how long you’ve been trying, the odds of conceiving on your own may be higher than it is for most infertility diagnoses. What does your unexplained infertility diagnosis mean and what doesn’t it mean? What are the possible explanations for your unexplained status? Is your infertility really unexplained? 

In so many ways, unexplained infertility is a controversial diagnosis. Your doctor has determined you do not have one recognizable condition or problem, and yet, you’re not able to conceive. However, while one doctor may diagnosis your case as unexplained, another fertility specialist may say you just haven’t been fully evaluated. And that doctor may be right.

Unexplained infertility can only truly be diagnosed after a full and complete fertility evaluation of both you and your partner. 

If your fallopian tubes are open and healthy, your ovarian reserves are good and your partner’s semen analysis is normal (including total count, sperm movement, and sperm shape), you may have an unexplained infertility problem. 

If any of these has not been evaluated, a diagnosis of unexplained infertility may be premature. 

Some may also argue a laparoscopy is also needed to rule out endometriosis that cannot be diagnosed with blood work or ultrasound. But unless you’re experiencing painful periods, your doctor may not consider the risk of the surgical laparoscopy worth making a diagnosis. 

Unexplained infertility isn’t a magical condition. There is a reason you are not conceiving but no one knows what it is. There are things that may be known that may cause problems, but don’t have a way to measure or evaluate yet. There are a variety of possible explanations for unexplained infertility.

You may have an undiagnosed underlying (non-reproductive) medical condition. 

After ejaculation, sperm must make their way out of the semen and into the cervical mucus. Then, they must swim up from the vagina, into the cervical opening, and eventually into the uterus. Sometimes, there may be problems during that transition period, from the semen, into the cervical mucus, and up the cervix. For example, there may be antibodies in the cervical mucus or even the semen that attack the sperm.

This is known as hostile cervical mucus. How to effectively diagnose this problem isn’t clear, leaving cases like these frequently unexplained.

Some kinds of poor sperm quality are not recognizable. For example, poor sperm shape (also known as morphology) may cause fertility problems. Poor sperm motility (or movement) may also cause infertility. But these are diagnosable. They can be seen during a semen analysis. There may be issues related to sperm quality that are not obvious during semen analysis. The sperm may have poorer quality DNA. These DNA issues increase as a man ages, which is why children of older fathers are at an increased risk for certain birth disorders and mental health problems. 

Poor sperm quality may be diagnosed during IVF treatment. If good-looking sperm can’t seem to fertilize healthy looking eggs, this may indicate problems with egg or sperm quality.

You can have a healthy cervical environment, healthy eggs, and healthy sperm, but if the resulting healthy embryo can’t implant into the endometrium, we have a problem. There is so much unknown about possible fertility problems related to the endometrium.

Let’s say we get a healthy looking egg and sperm, and they become an embryo. Next, the cells inside the embryo divide and grow to eventually form a fetus. Sometimes, this goes wrong. This is another problem that may be diagnosed during IVF treatment since embryos are monitored for normal cell division. This problem with the embryo is usually common in older women. 

It is not completely understood how poor health impacts fertility in more subtle, not yet measurable ways. It may be that the cause of your unexplained infertility is completely unknown to medical professionals at this time. 

Many couples with unexplained infertility go on to conceive without any treatment help within one to two years of diagnosis. 

A healthy, fertile couple has about a 30 percent chance of conceiving in any given month. 

It could be you have a very subtle fertility problem, but not so much that you can’t conceive on your own with more time. 

Your possible physical problem is also just as real, even if it can’t or hasn’t been diagnosed yet. When you want to get pregnant, but you can’t, this is all worthy of attention and concern. 

If your doctor diagnoses you with unexplained infertility and tells you that you just need more time, you may also want to consider a second opinion. While this is true for some couples, and can be good advice in some situations, it’s not so for everyone. 

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