When the results of a standard infertility evaluation are normal, we assign a diagnosis of unexplained infertility. This may also mean that the presently available tests and techniques are unable to pick up the cause whatsoever. Approximately 15% to 30% of couples will be diagnosed with unexplained infertility after their diagnostic workup. Let’s read about infertility tests, diagnosis and treatment of unexplained infertility, and the use of laparoscopy for unexplained infertility.
Standard Infertility Tests include:
- Semen analysis for the male partner
- For female partner: assessment of ovulations through history/ultrasound/urine/blood tests
- Assessment of uterus and fallopian tubes:
A) HSG / Laparoscopy for tubal evaluation
B) Ultrasound for evaluation of the uterus and to rule out polyps/fibroids/synechiae/malformations
These are the standard infertility tests. Now let’s take a look at the use of laparoscopy for unexplained infertility.
Role Of Laparoscopy In Unexplained Infertility
Given that it allows direct visual examination of the pelvic reproductive anatomy, it is the test of choice to identify otherwise unknown potential/tubal/ovarian factors that influence fertility, especially endometriosis and pelvic adhesion. Laparoscopy for unexplained infertility should always be combined with hysteroscopy for a complete evaluation of the uterus along with tubes, ovaries, and peritoneum. Thus Use of Laparoscopy for unexplained infertility is vital.
Expectant Observation With Timed Intercourse And Lifestyle Changes
Includes correction of thyroid and Prolactin, achieving normal BMI, reducing coffee intake to 2 cups a day, and reducing alcohol intake to not more than four standardized drinks per week. With a proper understanding of the fertile period, all these can produce a successful pregnancy in 1.3% to 4.1% of couples. This is based on the understanding that routine infertility evaluation misses subtle defects. Although expectant management is associated with the lowest cost, it results in the lowest cycle fertility rate and is inferior to the commonly available reproductive techniques outlined below.
Ovarian Stimulation With IUI
The rationale is that subtle ovulatory defects missed by standard testing may be overcome and that multiple ova available for the fertilization may increase the chances of pregnancy. Also, introducing washed sperms into the uterine cavity increases the number of sperms available for fertilization. This method offers a success rate of 15% to 16% per cycle.
IVF and ICSI Treatment
The most successful treatment for unexplained infertility is IVF – ICSI treatment. ICSI can take care of an undetected fertilization problem. As per the SART 2006 data, 126,726 completed cycles with a 40.4% live rate for women < 35 years of age and 38.9 % for women 35-37 years of age. This process also facilitates the selection of good-quality embryos, thus helping to overcome implantation defects. Therefore, IVF & ICSI Treatment is the choice in the case of unexplained infertility. It may be expensive compared to other treatment methods, but it also offers the highest success rate.
By Dr. Aanchal Agarwal, Sr. Consultant, IVF and Infertility Treatment, BLK Super Speciality Hospital, Pusa Road, New Delhi 110005