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Main article: Unexplained Infertility Overview
Updated: 3-April-2024
Diagnosis of Unexplained Infertility
Unexplained infertility is diagnosed after standard fertility investigations fail to identify a common cause of infertility.
It is important for doctors to carry out all standard fertility investigations before making a diagnosis of unexplained infertility. This is more likely to identify a potential cause of infertility and or guide doctors towards a more suitable treatment option.
Hamilton et al. reported that undertaking all standard fertility investigations results in a higher chance of pregnancy and shorter time to pregnancy for couples with unexplained infertility.
Source: Hamilton J, et al. (2021)
Standard fertility investigations for females includes:
- History taking (menstrual, obstetric, contraceptive, sexual, medical, surgical, family, social)
- Physical examination (general, breast, abdominal, genital)
- Infection (HIV, hepatitis B, hepatitis C, sexually transmitted diseases)
- Hormone levels (Progesterone, FSH, LH, SHBG, TSH, androgens, prolactin, AMH)
- Transvaginal ultrasound scan (polyps, fibroids, adhesions, ovarian cysts, polycystic ovaries, stage 2-4 endometriosis, tubal disorders)
- Hysterosalpingogram (HSG) or HyCoSy (tubal patency and uterine cavity)
Thorough assessment of the uterine cavity commonly identifies abnormalities in at least 1 in 4 women with unexplained infertility.
Source: Izhar R, et al. (2018)
Standard fertility investigations for males includes:
- History taking (general, sexual, medical, surgical, family, social)
- Physical examination (general, breast, abdominal, genital)
- Infection (HIV, hepatitis B, hepatitis C, sexually transmitted diseases)
- Semen analysis (minimum of 2 samples)
Even though semen analysis is widely accepted to be a poor predictor of male infertility.
Therefore most experts will usually recommend additional investigations in couples diagnosed with unexplained infertility.
Additional investigations for females include:
- Laparoscopy (stage 1 endometriosis, pelvic adhesions, tubal disease)
- Post-coital test
- Hormone tests (Leptin)
- Infection (Bacterial vaginosis)
- Immune tests (Natural killer cell, Th1/Th2, T helper 17 cells, Endometrial Decidualization Score, Human Herpesvirus 6A, B cell CLL/lymphoma 6, antiphospholipid antibodies, antinuclear antibody, thyroid autoimmunity)
- Tubal peristalsis
