Would an unexplained infertility be unexplainable?

Since I really don’t like the term ‘sterility’, I prefer to use ‘infertility’ instead.

When we investigate the couples who could not have baby, we may not find any underlying reason in 10-12% of them. The diagnosis of these couples, then is called ‘unexplained infertility’. It is important to remember that this is not about the underlying reason’s absence, this is about the technology of today all over the world is not sufficient to identify the real problem.

We are able to identify the problems to 85-90% extend, by evaluation of uterus and uterine tubes with imaging techiques, mapping of the intrauterine tissues with ultrasound devices, and examining the speriogram and oocyts reserve thoroughly. Additionally, the micro-abnormalities in oocyts or sperm would not only decrease the fertilization rate, but also some geteics and acquired factors could also have an impact on obtaining the healthy embryos. On the other hand, uterus and uterine tubes which are identified as anotomically normal, is not a referrence for perfect functionality. As we all see, it is more complex then it seems.

This group of couples whom the exact reason of infertility could not be diagnosed, the natural pregnancy rate is seen around 3-5%, whereas in the couples below 35 years of age who got assistance for pregnancy, this rate is around 15-20%. In fact, the natural pregnancy is a one of the options yet, in the couples of unexplained infertility. The medical practice is to take these couples in the treatment program in the end of one year, as the time passing by would be against of us.

At the point of undiscovery of the reasons of infertility, I want to emhasize that there is no one or other party’s responsiblity or fault, instead this is the couple’s challenge to deal with. The case is ‘ours’, and the couple as united starts to make effort to overcome the infertility and to look forward to come together with the expected baby, rather than accusing or using negative wording in communication.

Unexplained medical issue is the problem that we are not able to identify despite the contemporary medical capabilities.  The intrauterine insemination success in these couples is about 10-15% per attempt, that is why for woman below 35 years of age, there could be 2-3 cycle attempts. If these attempts are unsuccessful, or if the woman is above 35 years of age and the infertile period is longer than 2 years, directly in vitro fertilization can be applied.

With my sincere wishes for all your dreams come true…

Egemen Koyuncu, MD

Gynecology and Obstetric Surgeon

---