I hear this question from patients all the time- practically every day.   In approximately 10-20% of our patients, we cannot find the specific reason for their difficulty in conceiving.  This is called "idiopathic" or "unexplained sub-fertility," and is very frustrating for patients because no one likes a mystery when it comes to their own health and dreams.   

We all want answers, especially after completing an exhaustive fertility evaluation, and in a subset of patients, we cannot pinpoint the exact problem.  It is maddening for you because you want an answer, and it is frustrating for your physician because we are problem solvers who want to "fix something" to help you meet your goals. 

Sometimes knowing "why" there is a problem helps a little bit on your journey, and allows you to bear it little more easily.  As a couple, you may feel somewhat envious of your friends who know the cause of their inability to conceive and can "Google" every bit of news or cutting-edge technology that pertains to them.

So what does it mean? Well, at first look, the good news is your physician did not find a major, impossible problem that cannot be fixed. Unexplained fertility issues usually reflect a subtle problem that may be at the molecular level and cannot be diagnosed with current medical technology.   It likely means that things are a little less efficient in your reproductive process; it is NOT a predication that you cannot conceive. 

The treatment options for patients with unexplained fertility issues are the same as those for patients with more easily identifiable diagnoses.  Treatments may include pills, injections, inseminations, IVF, ICSI, reproductive surgeries and others.  Advanced treatments such as IVF (In Vitro Fertilization) are diagnostic in nature for those of you with unexplained infertility as well as giving you an excellent chance to conceive. For example, it gives your physician more diagnostic information on the ovaries, eggs, hormones, sperm, fertilization and embryos as well as bypassing many problems that cannot be diagnosed yet with current medical technology.  

The underlying message that I am trying to communicate is that even when every test is normal, unexplained sub-fertility reflects the present limitations of medical science.  It does not mean that you will be unable to conceive.  It is, however, a clinical clue to you and your physician to be a little more aggressive in your treatment options- for your benefit.  It also is a hint that continuing to conceive on your own is inefficient and unlikely to result in the family you are trying to create.

With unexplained infertility, your ultimate curiosity may not be answered as to why you were unable to conceive without help, but you still have an excellent chance at building your family.  The journey you take to do so may not be the one you anticipated, but with help, it is highly likely that you will succeed in fulfilling your goals and dreams. 

Joshua M. Hurwitz, MD- Reproductive Medicine Associates of Connecticut

Joshua M. Hurwitz, MD
Dr. Joshua Hurwitz is a Partner in Reproductive Endocrinology at Reproductive Medicine Associates of Connecticut (RMACT) and is board-certified in both Obstetrics & Gynecology and Reproductive Endocrinology and Infertility. Dr. Hurwitz joined the practice in 2006 with a passion for patient care and teaching. In addition, he is Division Director of Reproductive Endocrinology and Infertility (REI) services in the Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital.
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