Unexplained Infertility Overview

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Updated: 15-August-2023


Unexplained infertility is defined as the failure to conceive after 12 months of regular unprotected sexual intercourse and no identifiable cause following standard fertility investigations.

It’s important couples undergo all standard investigations before accepting a diagnosis of unexplained infertility.

Surprisingly unexplained infertility is quite common. In fact, about one third of infertile couples are diagnosed with unexplained infertility.

As a result, couples can become anxious and depressed, especially the female partner. Having a good support group around you is essential.

Significantly, studies show the chances of spontaneous pregnancy is much higher in couples with unexplained infertility than those diagnosed with a known cause of infertility.

This is important to consider when weighing up the various treatment options.

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.

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)

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.

Causes of Unexplained Infertility

A diagnosis of unexplained infertility does not necessarily imply there is no known cause. Instead, unexplained infertility simply means the cause was not identified during standard fertility investigations.

Nevertheless, additional investigations usually identifies the cause (or causes) of unexplained infertility in the majority of couples.

The causes of unexplained infertility fall into 3 main categories:

  • Medical
  • Environmental
  • Genetics

Treatment of Unexplained Infertility

Treating unexplained infertility is a step-by-step process for couples. The first step towards treatment is diagnosing the possible cause (or causes) of unexplained infertility.

Once all the test results have come back, your Doctor will recommend one (or a combination) of the following treatment options for unexplained infertility:

  • Lifestyle
  • Medication
  • Expectant Management
  • IUI
  • IVF
  • Surgery


Questions or comments?