Infertility is a pretty stressful problem for loving couples who want to have a baby. One of the most frustrating diagnosis in reproductive medicine is so called "unexplained infertility" which is used to describe a couple who have been trying to conceive for a year or more, and despite undergoing all most modern fertility tests, no reason can be found to explain the infertility. In cases of unexplained infertility no firm strategy and guidelines can be provided and chances for pregnancy are actually not known. Doctors cannot tell about whether conception is ever likely, how much longer it may take, and whether assisted conception should be considered immediately or in the longer term.
It is known that about 10-20% of couples experiencing fertility problems will have unexplained infertility. Although it is hard for a couple to learn why they are infertile, learning that there doesn’t seem to be any explanation for your infertility can be even more difficult.
There are two groups of infertile couples who “suffer” from unexplained infertility:
- couples who are just unlucky and don't have any medical and/or biological problems which could be considered as a cause for infertility;
- couples who most probably have a medical reason for infertility, but infertility cause cannot be discovered due to insufficient medical knowledge or technology.
UNEXPLAINED INFERTILITY diagnosis
In most cases the diagnosis of unexplained infertility is based on exclusions of all possible infertility causes. Unexplained infertility can be confirmed only if the following tests demonstrated good results:
Ovulation is occurring normally (time and sizes) on a monthly basis;
Fallopian tubes are open (not blocked) and healthy;
Hormone profiles are normal and adequate according to the menstrual cycle days;
The lining of the uterus is of adequate thickness according to the menstrual cycle days and ready for implantation on correct time;
Endometriosis is excluded (using modern methods);
Pelvic adhesions are excluded (using modern methods);
Anatomic structures of reproductive organs are normal (absence of pathology, absence of fibroids and polyps);
Absence of vaginal infections including STDs;
Positive postcoital test.
UNEXPLAINED INFERTILITY possible causes
The quality of eggs is very important. In general ovaries can produce eggs every month but not all of these eggs are suitable for fertilization and division. Eggs need to be of the proper shape and size and must contain the right chromosomes to be successfully fertilized and implanted. If the quality of ovulated egg is not perfect, fertilization and implantation could be a problem and the couple could have problems getting pregnant.
Luteinized Unruptured Follicle (LUF) Syndrome
Normal ovulation is a crucial component in fertility. During ovulation, it is possible for eggs to become trapped in the sac that protects them - while maturing, eggs are kept inside of a tiny membrane, called a follicle and when stimulated (by specific hormonal medicine), this follicle bursts to release the egg. The egg then moves into the fallopian tube and the leftover membrane becomes the corpus luteum. Sometimes though, a follicle can become a corpus luteum before rupturing, trapping the egg inside (instead of ovulation). As a result, ovulation never occurs.
Sometimes, unexplained infertility is actually caused by tiny abnormalities in Fallopian tubes which contain structures that help to sweep ovulated egg inside. The fimbria are finger-like projections located at the ends of each fallopian tube - they grab onto ovaries, helping to coax the egg inside. Both Fallopian tubes also contain cilia, tiny hairs that help to move the egg down into the uterus. Sometimes, there are problems with the fimbria or cilia, which can prevent ovulated egg from being fertilized.
Problems in Luteal Phase
It is well known that the period after ovulation called “luteal phase”of the menstrual cycle. During luteal phase, the corpus luteum begins to produce hormone progesterone which is responsible for uterus preparation - endometrial lining for implantation. Sometimes the level of progesterone could be changed (reduced or increased for several reasons) and as a result, the endometrium doesn't become properly prepared for implantation.
In general the immune system is designed to protect body from invading “unknown” and “unexpected” cells and organisms. Immune system is responsible for killing off disease and infection. Sometimes the immune system can be “damaged” and confused (because of strange signals from brain and organs). Changed immune system can start fighting and attack own body cells (eggs). Male partner's immune system could even be attacking sperm cells, causing them to stick together, become immobilized, or even die.
Different types of infections and especially vaginal infections and also sexually transmitted infections could create problems for normal fertilization and implantation processes. Sometimes infection is not detectible by laboratory tests because these particles exist in such small numbers that they are undetectable through examination.
In order to become fertilized, sperm must be able to break through the outer shell of you egg. Sometimes, even healthy-looking sperm cannot break through the egg in order to create an embryo. The quality of spermatozoids is crucial.
Stress and Emotions
Stress and emotions can play a very important role in infertility – important for both partners (females and males). The entire reproductive system and reproductive functions are controlled by the brain. Any stress and/or negative thinking and/or emotional distress can sometimes interfere with the brain's ability to control the reproduction in couples. For example, the depression has been linked with decreasing of women ability to get pregnant. Unfortunately reproductology experts aren't exactly sure how or to what degree stress and emotions can play a role in infertility but it is recommended to try to avoid stress and/or use stress management tools. Sometimes just changes in life could have positive influence at psychological component of your fertility – change of house, styles, habits, atmosphere, etc. You might want to think about redecorating your home or office in order to create a more relaxing environment in which to focus on your thoughts and on your body.
Prematurely Aging Ovaries Syndrome (PAO)
It is noted in women after 35. As a woman ages, the number of follicles within the ovaries decreases, causing infertility. PAO occurs when this process happens to younger women, well before menopause.
UNEXPLAINED INFERTILITY treatment
If you receive a diagnosis of unexplained infertility, there is no reason to give up hope. There is still a good chance that you will get pregnant on your own, without any fertility treatments. In fact, your chances of getting pregnant within three years are over 30%.
For couples with unexplained infertility, treatments such as Follicular tracking, Clomid or Intrauterine Insemination (IUI) could be offered prior to the more invasive treatments such as IVF.
Unexplained Infertility – 6 Steps When You’re Not Conceiving a Baby
By Laurie Pawlik-Kienlen
Unexplained infertility doesn’t mean there is no reason for not getting pregnant…it just means that the reason for not conceiving is unidentified at this time.
6 Steps to Take When You’re Not Conceiving a Baby
1. Make sure it’s really “unexplained infertility” – not “undiagnosed infertility.” Remember that fertility doctors and reproductive endocrinologists are human – which means they make mistakes! One fertility specialist can miss something that another could catch right away. Missed diagnoses and misdiagnoses aren’t necessarily because some doctors are better than others; it just means that different doctors have different education, experiences, and specialties. If you’re not satisfied with your doctor’s opinion or diagnosis, you need to get more information.
2. Get a second opinion. No matter how much you like your fertility clinic or doctor, get a second opinion if she gives you an “unexplained infertility” diagnosis. Look for different types of infertility specialists or fertility treatment centers in your area, such as hormone doctors and naturopaths. Contact infertility support groups and forums to get more information on possible specialists. And, get a copy of your medical tests and reports to take to your new clinic or doctor.
3. Do all the routine fertility tests - minimum a semen analysis, documentation of ovulation, ultrasound of uterus and ovaries, and an HSG. HSG is the X-ray that evaluates the fallopian tubes and the uterine cavity. A semen analysis is a sperm test. The ultrasound looks at the uterus and ovaries to rule out severe endometriosis.”
4. Make sure you’ve completed these fertility tests for women:
- Ovulation testing. A blood test is sometimes performed to measure hormone levels to determine whether you are ovulating.
- Hysterosalpingography (HSG). This test evaluates the condition of your uterus and fallopian tubes. Fluid is injected into your uterus, and an X-ray is taken to determine whether the fluid progresses out of the uterus and into your fallopian tubes. Blockage or problems often can be located and may be corrected with surgery.
- Laparoscopy. Performed under general anesthesia, this procedure involves inserting a thin viewing device into your abdomen and pelvis to examine your fallopian tubes, ovaries and uterus. A small incision (8 to 10 millimeters) is made beneath your navel, and a needle is inserted into your abdominal cavity. A small amount of gas (usually carbon dioxide) is injected into the abdominal cavity to create space for entry of the laparoscope — an illuminated, fiber-optic telescope. The most common problems identified by laparoscopy are endometriosis and scarring. Your doctor can also detect blockages or irregularities of the fallopian tubes and uterus. Laparoscopy generally is done on an outpatient basis.
- Hormone testing. Hormone tests may be done to check levels of ovulatory hormones as well as thyroid and pituitary hormones.
- Ovarian reserve testing. Testing may be done to determine the potential effectiveness of the eggs after ovulation. This approach often begins with hormone testing early in a woman’s menstrual cycle.
- Genetic testing. Genetic testing may be done to determine whether there’s a genetic defect causing infertility.
- Pelvic ultrasound. Pelvic ultrasound may be done to look for uterine or fallopian tube disease.
5. Make sure you’ve completed these fertility tests for men:
- General physical examination. This includes examination of your genitals and questions concerning your medical history, illnesses and disabilities, medications and habits.
- Semen analysis. This is the most important test for the male partner. Your doctor may ask for one or more semen specimens. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. A laboratory analyzes your semen specimen for quantity, color, and presence of infections or blood. A detailed analysis of the sperm also is done. The laboratory will determine the number of sperm present and any abnormalities in the shape and movement (motility) of the sperm. Often sperm counts fluctuate from one specimen to the next.
- Hormone testing. A blood test to determine the level of testosterone and other male hormones is common.
- Transrectal and scrotal ultrasound. Ultrasound can help your doctor look for evidence of conditions such as retrograde ejaculation and ejaculatory duct obstruction.
6. Consider alternative medicine, such as acupuncture. Though alternative medicines (natural herbs or supplements, yoga for fertility, acupuncture for fertility, etc) have not been proven effective in medical science research or journals, there is anecdotal evidence that Chinese medicine therapy helps women get pregnant. Of course, it depends on the reason for your trouble getting pregnant – acupuncture or herbal supplements can’t solve every health problem! But, if you’ve tried every fertility test and have been diagnosed with unexplained infertility, why not give traditional Chinese medicine a try?
(information from - http://theadventurouswriter.com/blogbaby/unexplained-infertility-not-conceiving-a-baby/)