Fertility Chronicles is proud to present a special blog series, “From the Fertility Experts,” where leading fertility experts answer commonly asked questions for patients about their fertility health and treatment options. We hope this series can help patients navigate their personal fertility journeys.—Catherine T. Yang, Editor, Fertility Chronicles
Univfy’s “Fertility Chronicles” guest blogger Dr. Jacqueline Gutmann shares her advice on unexplained infertility:
If you’ve been told that you have unexplained infertility, you’re not alone. The condition affects about 20% of couples. Unexplained infertility means that after conducting all the appropriate tests, doctors can’t find a reason why a couple isn’t conceiving. Prior to concluding that you have unexplained infertility, your doctor will try to perform a number of tests to determine the reason that you have not conceived. But some causes can be tricky to find. When trying to get to the answer, here are some conditions your fertility specialist may look for:
Problems with the ovaries
If you are not ovulating regularly, your doctor may try to determine whether you have polycystic ovarian syndrome (PCOS). With PCOS a woman has abnormal hormone levels that can lead to irregular ovulation or no ovulation at all. The problem also could be thyroid hormone levels that are too high or too low. Being significantly underweight or overweight can also affect ovulation. The issue can also be having too few eggs or poor egg quality. These causes could all be independent of each other.
Problems with sperm
For men, infertility could be the result of a low sperm count, abnormally shaped sperm, or sperm that die before they can reach the egg to fertilize it. This can be tested by checking a semen sample to evaluate a man’s sperm count, their motility, and their shape. Other issues can affect a man’s fertility, including an obstruction or antibodies that actually attack the sperm as they approach an egg.
Problems with the fallopian tubes
A woman having trouble getting pregnant may have blocked fallopian tubes, most commonly caused by infection. Damage caused by this previous infection could lead to a condition called hydrosalpinx, in which the tube or tubes with the blockage contain fluid that distends the tubes. Endometriosis – in which the uterine lining grows outside of the uterus – can also damage fallopian tubes, as can scar tissue from pelvic surgery.
Problems with the uterus
Uterine fibroids or polyps may interfere with an embryo implanting in the uterus. The doctor may also check for an oddly shaped uterus, which a woman may have had since birth. This can be diagnosed by ultrasound or other imaging techniques. Depending on the type of abnormality, you can often conceive, or the abnormality may be able to be corrected before you try to get pregnant.
If a couple is having trouble conceiving for reasons that can’t be explained, fertility specialists may recommend three to six tries using intrauterine insemination (IUI) where washed and concentrated sperm are delivered directly into the uterus through a catheter. Fertility medications are typically used with IUI. But with IUI, no one can see the eggs or the embryos, and if it doesn’t work, your doctor still won’t know what’s wrong.
If medication with IUI is not successful, you still have a good chance of conceiving using in vitro fertilization (IVF). With IVF, a woman is given drugs to stimulate egg production. Then the eggs are harvested from her ovaries, and in a laboratory, the sperm and eggs are put together to fertilize and grow into embryos. After that, one or more embryos are placed directly into the woman’s uterus.
Though it is frustrating not to have a clear explanation for your infertility, treatment of unexplained infertility with either medication coupled with IUI or IVF is often successful.
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