Unexplained Infertility
Unexplained infertility is defined as 2 years’ infertility in a couple who are having regular intercourse and in whom there are no clearly identifiable causes for their problem. This is a very frustrating diagnosis which is found in about 30 % of couples who present for investigation of infertility.
The main features of “unexplained” infertility are:
- Ovulation confirmed or successfully treated
- Fallopian tubes normal.
- None or only mild endometriosis
- Normal sperm parameters
Rationale for treatment:
There are several options for a couple with “unexplained” infertility ranging from expectant treatment, through intrauterine insemination (IUI) to Intracytoplasmic sperm injection (ICSI).
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- Couples who have no explicable cause for their infertility may still conceive naturally even though they may have been trying for a long time. The chances of a spontaneous pregnancy are determined by a number of factors including the age of the woman, the length of time the couples have been trying to become pregnant and whether the female partner has been pregnant before. The longer time goes on, the less chance there is of a natural pregnancy.
- Intrauterine Insemination with stimulation of the ovaries (IUI and Controlled Ovarian Stimulation COS):
- To improve the woman’s fertility by enhancing her ovulation by increasing the number of eggs which are produced to more than would have been the case naturally.
- To time when the eggs are ripe by scanning the ovaries.
- To prepare the sperm by wash, centrifugation and swim up into culture medium, thus improving its quality and its fertilization potential.
- To inseminate the sperm directly into the uterine cavity at a precisely determined time to ensure the sperm is as close to the egg at the time it is released, and to by-pass any possible hostile effects of the cervical mucous on the sperm.
The current guideline from the National Institute of Clinical Excellence is to recommend 6 cycles of IUI.
- Intracytoplasmic sperm injection (ICSI):
The rationale is to witness the process of fertilization during the ICSI cycle. One of the possible diagnoses in a couple with “Unexplained Infertility” is that the egg and the sperm are incompatible when placed together. The laboratory tests we normally carry out on sperm are a relatively poor indicator of fertilizing potential.