Diagnosis of Unexplained Infertility

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.

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)

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.

Additional investigations for females include: