Unexplained Infertility – No One’s Fault!
CHA Fertility Center’s Medical Director Dr. Joshua Berger says infertility, including unexplained infertility, is no one’s fault!
Many women spend much of their early adult lives trying not to get pregnant. But when you finally do want to start a family and it doesn’t happen right away, it can leave you feeling frustrated. Not to mention, trying to get pregnant month after month unsuccessfully can be emotionally taxing. You should know that you are not alone, and that unexplained infertility is exactly that– unexplained– so no finger pointing as to who is at fault!
Definition of Infertility
One in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. Infertility is defined as the inability to get pregnant after regular sexual intercourse without the use of any contraceptive methods for 6 months for those 35 years old or over, or 12 months for those under 35.(1) Under normal circumstances the ability to get pregnant is at the most 25% each month. This number declines over time and starts to decline more rapidly once a women reaches her thirties, so that by age 35, the likelihood of getting pregnant each month is down to about 15%, and by age 40 it’s down to less than 10%.
Causes of Infertility & Unexplained Infertility
Infertility is a medical condition, and a fertility specialist can help with thorough, focused examinations directed at discovering the underlying cause. For every couple that begins an evaluation, about 35% discover that there is an issue with the man which is contributing to the couple’s infertility. 50% is related to female factor while 5% is due to rare causes. The remaining 10% (1 in 5 couples) is due to unexplained infertility despite completing a full infertility work-up.(2)
The common thing that happens once learning about the unexplained infertility diagnosis is shifting blame or incurring guilt. You may feel a sense of individual responsibility for the news, and be concerned about the effects that this will have on your relationship and your current partner. Perhaps you feel like you waited too long to start a family or have anxiety finding the right parenting partner that you associate now with your infertility. Remember, it’s no one’s fault.
It’s understandable to be upset and confused. One thing to remember is that your efforts and energy are best spent finding the optimal treatment options for your situation rather than focusing on the diagnosis.
Factors in Fertility
In order for pregnancy to happen, sperm has to meet the egg. This normally takes place at the end of the fallopian tube, and this is called fertilization. There are a number of obstacles that can prevent this from happening, and the process itself even in healthy young fertile women is very complex- hence the low pregnancy rate each month. Obstacles such as cycle timing, low sperm count, poor sperm motility, blocked fallopian tubes, or endometriosis must be overcome to achieve a pregnancy. Timing is often the most common obstacle to conception. What does it mean for you when common causes of infertility are ruled out and you’re told you have unexplained infertility? It should mean a time of hope.
Over the past decade, significant advances have been made in the treatment of reproductive disorders which can help even those with a diagnosis of unexplained infertility.(3) Knowledge about our lifestyle, nutrition, hormonal imbalance, and even the environment can impact our fertility.
Other health related problems could also cause poor egg health, low ovarian reserve, or abnormal immunological responses, which can affect conception. Stress could also play a role. We all know that menstrual cycles can be altered during times of extreme duress- and this can be emotional, physical, or environmental stressors. In these instances, the first steps should be to avoid life stressors, maintain a healthy weight, routinely exercise, avoid smoking, and reduce alcohol intake, all of which may be contributing to unexplained infertility issues.
Staying Hopeful: Our Fertility Specialist Can Help
Addressing lifestyle issues is not meant to be a quick fix, and typically does not lead to instant success. However, with unexplained infertility every little bit counts, so don’t fret or give up. Do not assume just because the cause of infertility is unexplained, it is untreatable or there is no pathway to parenthood. When a specific cause is not determined for women, and male infertility has also been ruled out, our fertility specialist may begin a course of treatment to improve the chances of conception and pregnancy. The speed with which interventions are offered depends on each individual’s own needs and desires as determined by age and other factors.
There are multiple treatment options including using oral or injectable medications, intrauterine insemination (IUI), assisted reproductive technology using in vitro fertilization (IVF), or a combo of these solutions to help. A 2010 study called the FASTT trial indicated that in vitro fertilization might be the quickest and best route to pregnancy for couples with unexplained infertility.(4)
With a reproductive specialist’s expertise, a plan of action can be developed, bringing a sense of control to the diagnosis of unexplained infertility for a clearer picture of how to achieve your family dreams.
(1) 2006-2010 National Survey of Family Growth, CDC. http://www.cdc.gov/nchs/fastats/infertility.htm
(2) Reindollar RH, M.D. Regan MM, Neumann PJ, et al. Fertility and Sterility. A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. 2010. Vol. 94, Issue 3, Pages 88-899. http://www.fertstert.org/article/S0015-0282(09)00866-8/abstract
(3) Alexander Quaas MD, PhD and Anuja Dokras, MD, PhD. Diagnosis and Treatment of Unexplained Infertility. Rev Obstet Gynecol. 2008 Spring; Vol. 1, Issue 2, Pages 69-76. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505167/
(4) ASRM. Practice Committee of the American Society for Reproductive Medicine. (2006) Effectiveness and treatment for unexplained infertility. Fertility and Sterility, Vol. 86, Suppl 4, 5. S111-S114. November 2006. http://bit.ly/2kLZwj4