But when tests and investigations find no cause for the infertility in either partner, a further diagnosis of ‘unexplained infertility’ can be even more discouraging, because there is no specific cause or causes that can become the focus of treatment. However, it is important to know is that ‘unexplained infertility’ does not mean you cannot have the baby you want.

During a recent IFAASA webinar https://youtu.be/PoVJbrcPA4k?si=-Dl4TGs-2oA1-89P Dr Jo Pottow, Reproductive Medicine Specialist at Cape Fertility, explained what it really means to receive a diagnosis of ‘unexplained infertility’ and how the expert team of fertility specialists at Cape Fertility provides high quality individualised patient care to help couples facing unexplained infertility to achieve their family dreams.

What does ‘unexplained infertility’ mean?

Dr Jo says that ‘unexplained infertility’ – in most cases – simply means that the cause has not been found yet. It doesn’t mean there is no cause: it just means the tests did not reveal a cause yet.

This happens to 10-15% of couples, and if you’re given this diagnosis, it’s worth asking if there are other tests that could shed light on your situation. However, it can be extremely difficult for those with unexplained infertility to know when to stop looking for a cause, hanging onto the hope that the cause of will be revealed in the next test.

“However, I what I explain to patients who are facing unexplained infertility is that we can investigate and investigate and investigate, focusing on trying to determine the cause of the infertility. But this may begin to feel like being turned into a scientific experiment, just to get a diagnosis, and it can become very expensive. In the end, we want to focus on what our patients really want, which is not a diagnosis, but rather to have a baby.

“So, for example, it might be an option to do surgery, to see if a cause that can be treated is revealed by the surgery. But it may be that surgery is unnecessary, especially if the eventual treatment will remain the same. So, you don’t want to do surgery just to be able to say ‘Oh, OK, it’s not that’. And even if the surgery allows us to find something, will it change the treatment or will it simply lead to the same treatment option being offered? So, one must ask, ‘is the surgery warranted’? The truth is that sometimes it is very much warranted, and sometimes it is not, and it all depends on the couple receiving the treatment, and their unique set of challenges.”

What’s the next step?

Because infertility may be caused by a truly wide array of issues in both partners, at Cape Fertility we always start with the basics, which includes blood tests for both partners and a semen analysis.

Blood tests for the female partner will reveal what her thyroid is doing, what her prolactin levels are, and where her oestrogen and progesterone levels are sitting at the beginning of the month. The tests will also show if the FSH and LH hormones in the brain are talking to the ovaries, and what are they saying?

It is also necessary to ensure the body is ready to have a baby by, for example, testing for rubella immunity. There’s no point in providing treatments to achieve a pregnancy to a woman who doesn’t have rubella immunity – because German measles during a pregnancy will be dangerous to the baby. Another example is checking for sufficient vitamin D levels – because the ovaries need vitamin D to function optimally.

For the male partners, the basics include blood tests, infectious markers, and a semen analysis.

These basics are the starting point when looking for a cause for infertility.

No cause for infertility?

Sometimes all these test results come back normal, and the cause of the infertility is still unexplained.

Could it simply be that you are just waiting for a healthy, normal egg to be ovulated? The reality is that women are born with more abnormal eggs than normal eggs, and the number and quality of eggs also drop over time. And since women ovulate just a single egg every month, chances are good that it simply isn’t a normal egg.

Or perhaps the sperm that reached the egg were not normal, because men too produce far more abnormal sperm than normal sperm.

Or perhaps the conditions in the uterus are not ideal for conception. Or perhaps the uterus did not allow the implantation of the embryo, because it is not normal – and that is the job of the uterus, to ensure an abnormal embryo does not implant.

So it may be that even if the exact cause cannot be found, the treatment may remain the same to achieve the real objective, which is not to know the cause, but rather to have a baby.

Sometimes couples with unexplained infertility conceive naturally over time, especially if they are younger. Others may need standard treatments like fertility drugs, intrauterine insemination (IUI), or in vitro fertilisation (IVF).

The treatment of choice is often IVF, because IVF addresses so many of the challenges faced when trying to conceive.

IVF enables a bigger scoop of eggs, so the chance of finding a normal egg is far greater.

IVF also circumvents all obstacles to the fertilisation of egg, by putting the best eggs and healthiest, cleaned sperm together under controlled conditions in an advanced lab, or even inserting a single sperm into the best egg cell using ICSI (Intra Cytoplasmic Sperm Injection). During IVF, the embryos (fertilised eggs) are carefully incubated under ideal conditions, and can also be tested, before they are placed – at the ideal time – in the uterus that has been carefully prepared, to ensure the best chances of implantation.

So, even when infertility is unexplained – and the cause has just not yet been determined – tried and trusted fertility treatments such as IVF can still ensure that the ultimate objective is achieved: a pregnancy that results in a healthy baby, even while the cause of the fertility challenges remains unknown.

What to do if you face unexplained infertility

Your first step to finding the right treatment for unexplained infertility is to speak to a fertility specialist to help you understand the likelihood of conceiving with and without treatment. This information can guide you in making the best decision for your unique circumstances.

At Cape Fertility, we value each individual patient and we look forward to providing you with individualised and personalised care, affordable quality fertility treatment, and higher success rates at our purpose-built premises in the beautiful city of Cape Town where we provide all the latest assisted reproduction techniques (ART) with great success.

If you would like to meet one of our fertility specialists, simply contact us by clicking here…