Unexplained Infertility – What Does This Diagnosis Mean?

Sound familiar:  You’ve been trying to get pregnant for over a year, you are under 35, in reasonable health and unfortunately you haven’t been successful. You go to your OBGYN and they refer you to an REI. You are apprehensive, nervous, and yet hopeful. Then you get the “unexplained infertility” diagnosis. Well great – what does that mean.

Many clinics will cite the good news / bad news analogy. Hey at least none of the standard fertility tests show a cause of your infertility (the good news) but we don’t know why you aren’t getting pregnant (the bad news). 

That’s frustrating & quite frankly, disingenuous.

First let’s break down the facts:

You aren’t alone.

The American Society for Reproductive Medicine (ASRM) states that up to 30% of couples struggling to become pregnant have a diagnosis of “unexplained infertility”.

How is an “Unexplained Infertility” diagnosis determined?

ASRM determines this diagnosis when there is an evaluation of “at least one patent fallopian tube, documentation of ovulation of the female partner, and a semen analysis with an adequate number of motile sperm for the male partner” and the tests come back “normal”1.

The tests performed on both partners usually are a semen analysis to check sperm count and characteristics for men, and for women, an evaluation of ovulation, ovarian function, and various hormonal tests like your Day 3 FSH and AHM levels. 

However, our own Dr. Natalie Cekleniak cautions using “normal” tests as an elimination marker for determining an “unexplained infertility” diagnosis. That the term is antiquated and misleading.

What your initial round of standardized tests are a great indicator of, is whether anything is presenting obviously “abnormal”. What they aren’t a great predictor of, is the quality of your eggs or your egg reserve.   

Dr. Cekleniak notes: The “normal” results do not mean this is a mystery case – it means that there are fewer good quality eggs, so conception is much more difficult.”

What are your next steps after getting an “Unexplained Infertility” diagnosis?

If you don’t check off some of the infertility “red-flags” like age, and pre-existing conditions, and your initial tests don’t show anything abnormal; you shouldn’t be patronized with a pat on the head, told to go home and just keep on trying. You haven’t done anything wrong. You were absolutely correct to address the situation with your doctors. 

Here at IRMS, we would partner with you to map out a treatment plan that fits your individual needs and comfort level. We may recommend you start with an IUI treatment with or without Clomid (an oral stim medication) or an injectable FSH medication (hormone drug used to stimulate your ovaries). It might make more sense to go straight to IVF, which can be more of an initial investment then one cycle of IUI (depending on your insurance coverage), but has much higher success rates which can prove to be more cost effective in the long-run. You can read further on the difference between IUI and IVF here on our site. If your own eggs and sperm aren’t making it happen, then using an egg or sperm donor can be another solution. 

We just want to let you know – you do have options and you truly aren’t alone. That an “unexplained infertility” diagnosis doesn’t mean you can’t have a family or you need to put your dreams of conceiving on pause. Our whole team of physicians, embryologists, counselors and nurse advocates are here to empower you forward along your journey. 

For more information about unexplained infertility diagnosis and your pathway to parenthood, please feel free to contact us through our website, DM our social handles or by calling us at 973.548.9900


1 Evidence-based treatments for couples with unexplained infertility: a guideline ASRM.org

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