A couple, wife (30yrs) and husband (32yrs), has been trying to have a baby for 3 years. All tests performed are normal. But, they have not been able to conceive. This can be termed as unexplained infertility.
A systematic and standard evaluation of all couples with infertility involves three initial tests, namely:
- Confirmation whether ovulation or egg release is occurring.
- Assessment of tubal patency by either an x-ray test called hysterosalpingogram OR laparoscopy.
- Semen analysis.
Now, the diagnosis of unexplained infertility is made when the results of all these tests are normal, and the couple has been trying for a pregnancy for at least a year.
The term unexplained infertility is a bit of a misnomer. It often means that there is something wrong at a more basic level. It could be due to subtle defects in the process of ovulation (egg growth and release) or in the process of fertilisation (when the egg and sperm meet to form embryo or due to poor egg, sperm or embryo quality). The third reason is that it could be due to defects in implantation (the process of embryo attaching to the womb lining and growth).
However, unexplained infertility is also very common, and 1 in 3 couples who are unable to conceive experience this.
In such a case, there are only two treatment options available
- Intra Uterine Insemination (IUI) involves insemination of husband’s sperm high into the cavity of the womb timed to coincide with the time of ovulation or egg release. This carefully timed procedure is further fortified with medication (oral/injectables) to increase the number of eggs produced in a treatment cycle.
- In Vitro Fertilisation (IVF) involves removing a number of mature eggs from the ovary, fertilising them in the laboratory using sperm and then transferring up to 3 (usually 2) fertilised eggs (embryos) back into the womb for implantation and further growth.
Normally, in one cycle of IUI, the success or the pregnancy rate is around 20%, and most pregnancies occur within the first 3-4 cycles of IUI treatment. Fertility specialists say, up to 6 cycles of IUI could be tried before moving to IVF.
Success or pregnancy rate with IVF is 50%, and cumulative pregnancy rate is very good at the end of 3 cycles.