A Fertility Specialist Explains Unexplained Infertility
Unexplained fertility simply means that the exact cause of a patient’s fertility issues cannot be definitively diagnosed. Dr. Douglas uses an extensive and detailed evaluation process but in about 10% of patients seen here at IVF Plano the diagnosis will remain undetermined. Unexplained Infertility is a diagnosis based on exclusion of all known conditions and causes following an extensive evaluation.
Causes of Unexplained Infertility
Problems with Fertilization
Fertilization is a very important step in pregnancy; if just one detail in the complicated process fails to happen… the pregnancy will not occur.
Eggs: As a women body ages so do her eggs and egg quality is the most important factor in achieving pregnancy. This is why most patients diagnosed with unexplained infertility tend to be over the age of 35. Even if an egg “looks” healthy under the microscope that doesn’t mean it will be able to make a baby. Chromosomal problems in eggs start to increase in women as they age and decrease a patient’s chance for conception. At 40, it is thought that over 80% of a woman’s remaining eggs may be chromosomally abnormal.
Treatment: IVF, ovulation induction with insemination, or donor eggs.
Sperm: Sperm have three jobs: navigate to the fallopian tubes for fertilization, break through the tough outer membrane of the egg, and deliver half of the genetic material. Even if a sperm has good motility and is chromosomally normal it must still break through the outer “shell” or the zona pellucida of the egg. In some couple’s with unexplained infertility it can be determined that the sperm lack the necessary enzymes needed to penetrate and fertilize the egg.
Treatment: Intracytoplasmic sperm injection (ICSI) or donor sperm
Tubes: Once a month when an egg is released from the ovary the fallopian tubes are drawn inward toward the ovary to catch the egg and allow the transport to the uterus. This process occurs with fimbriae or “fingerlike” projections on the ends of the tubes that sweep the egg into the opening. Once inside the tube, cilia move the egg along the tube and down into the uterus. In some cases of unexplained infertility it is thought that damage to the frimbriae or cilia can prevent the egg from being picked up or can effectively stop the movement of the egg through the tube, preventing the embryo from making it to the uterus.
Treatment: IVF, tubal surgery
Problems with Egg Implantation
Uterine Lining: After the egg is released from the ovary hormones are produced to ready the uterine lining for the arrival of the fertilized egg. Progesterone, the “pregnancy hormone” is responsible for the quality of the lining in the uterus at implantation. Sometimes there can be problems with the quantity and timing of the release of progesterone and as a result the lining of the uterus is not ready for the arrival of the egg. This dyssynchrony of the egg and lining is called a luteal phase defect and will cause a failure of implantation or miscarriage.
Treatment: progesterone supplementation with or without IUI
Embryo binding: Once the fertilized egg is in the uterus and the lining is prepared, the egg must attach to the lining and begin the process of creating a placenta. Many proteins and chemicals are involved in this complicated binding process. In patients experiencing unexplained fertility sometimes these binding factors are not present in sufficient quantities or in some cases present at all. These patients are not able to maintain a pregnancy even though all of the other factors are normal.
Treatment: Currently we do not understand this process well enough to have any accurate testing or treatments options to correct or diagnose the problem. Research has been ongoing for years and the progress has been slow.
Immune Problems: Your immune system is designed to recognize material that is foreign to your body and remove it. However in some patients their immune system may become confused and begins to attack “self” cells by mistake. In men, especially after a vasectomy reversal, the immune system can create antibodies to sperm. These resulting antibodies will attack the sperm cells causing them to stick together, inhibiting their ability to move, penetrate and/or bind to the egg. Women can have sperm antibodies also.
Treatment: sperm can be treated to remove antibodies prior to use in IUI or IVF procedures
Infection: Unexplained infertility can sometimes be a result of the presence of an infection in the body. A bacteria-like organism, Ureaplasma, can be present in the reproductive tract of individuals in such small numbers that there can be no visible symptoms. It is know that Ureaplasma can cause premature births but their exact effect on fertility is not known.
Treatment: Antibiotics such as Doxycycline
Psychological Barriers
Stress and depression have been shown to have a negative impact on infertility for both men and women. New research is being done to determine how and to what extent psychological barriers can affect a couple’s chance for conception. Understand that dealing with infertility is a highly emotional situation, take time to relax and if you need help seek the care of a licensed professional counselor.
Treating Unexplained Infertility
If you receive a diagnosis of unexplained infertility, there is no reason to give up hope. About 30% of patients with this diagnosis will achieve pregnancy on their own within three years. But seeking the care of a reproductive endocrinologist, like Dr Douglas early can help increase your chances of getting pregnant in a shorter period of time.
