Unexplained infertility is generally defined as patients who have had a “normal” evaluation and have been trying for longer than one year to conceive (if they’re less than 35 years old) or patients who are over 35 years and have been trying for six months to conceive. This includes a normal hysterosalpingogram which demonstrated a normal uterine cavity and bilateral fill and spill of the fallopian tubes. The semen analysis is typically also normal and ovarian reserve testing shows a normal number and normal quality of eggs within the ovaries.
While unexplained infertility is a very frustrating diagnosis to have, it has some of the highest success rates with treatment. Many patients tend to focus on the negatives, not knowing what is causing the infertility, rather than the positives, what is not causing the infertility. For example in the situation of unexplained infertility we know that the fallopian tubes are open and working, the uterus is normal in size and shape, the semen analysis is normal and the number and quality of eggs also appears to be normal.
Fortunately, unexplained infertility is not only the most common cause of infertility but it also is the form of infertility with the highest success rates with the simplest forms of treatment. With the diagnosis of unexplained infertility ovulation induction and intrauterine insemination typically results in pregnancy rates of 15 to 20% per treatment cycle. If ovulation induction and intrauterine insemination are unsuccessful, other forms of treatment such as donor eggs have very high success rates.
Common questions include, what could be the ultimate cause of infertility in patients with unexplained infertility? That is typically discovered through a diagnostic laparoscopy in which multiple studies have demonstrated that patients with unexplained infertility undergoing laparoscopy (a surgery typically performed in the hospital under general anesthesia) have at least a 50% chance of either having pelvic adhesions, endometriosis or other pelvic pathology causing the infertility. The obvious question is why don’t we proceed forward with surgery to make the diagnosis and treat the underlying disorder? The cost of surgery is typically very expensive ranging from $10-$15,000. The surgery has risks, but most importantly surgery does not improve success rates with subsequent infertility treatment such as ovulation induction and intrauterine insemination and does not improve the chance of pregnancy on your own without help.
Given the challenges described above in making the diagnosis of infertility in patients with unexplained infertility, the recommendation is that patients proceed forward with simpler forms of treatment which typically result in lower risks, lower costs and higher success rates. At Coastal Fertility Specialists, this usually consists of ovulation induction and intrauterine insemination treatment cycles using a combination of Letrozole and low dose gonadotropins which not only help to reduce the per-cycle cost of treatment, but also provides pregnancy rates of 15% to 20% per treatment cycle.