It can be extremely frustrating to undergo extensive infertility evaluation, only to be told that the reason of infertility could not be determined. For 10 to 15 percent of patients, there is no clear answer as to the source of their fertility struggles, meaning the cause may be beyond our current understanding or beyond the sophistication of our testing procedures.
In these cases, we carefully review the entire infertility evaluation:
- Each test is examined to ensure that it was performed correctly and is technically sound
- The conclusion drawn from the results is also examined
- Tests with questionable results may be repeated
Because we rarely perform routine diagnostic laparoscopy any longer, we are seldom making a confirmed diagnosis of endometriosis. So many patients with endometriosis will end up categorized as "unexplained." Since it makes no difference as to treatment, it is not so important to know a woman has endometriosis.
Many cases of unexplained infertility are usually age-related sub-fertility. That is, there is nothing really wrong, it's just taking longer to get pregnant because fewer eggs are chromosomally normal.
If a thorough review still provides no clues or leads as to the cause of a patient's infertility, we use a method known as empirical therapy, in which treatment is based not on conclusive evidence but on observation or experience with other infertile couples. The justification for empirical therapy is simply that it frequently works. Because a large number of our patients find success through Assisted Reproductive Therapies (ART), we also use this approach for patients with unexplained fertility.
By using hormonal therapy alongside artificial insemination technologies such as intrauterine insemination (IUI) or in vitro fertilization (IVF), we are able to cast a wide net and address as many fertility factors as possible.
Because ART techniques are based upon enhancement (such as hormones to increase egg production) and/or substitution, such as IVF to help with fertilization, they can be applied to unexplained infertility patients with the hope that what is being enhanced or substituted is the element responsible for the infertility.