TFC is explaining unexplained infertility
Explaining unexplained infertility is part of the job. A patient asked me this week why I felt she had unexplained infertility. She had been told by her gynecologist that several issues had arisen during their infertility evaluation. Her previous physician told her that she did not ovulate very well and he found endometriosis during a laprascopy. She had taken clomiphene citrate (Clomid, Serophene) and experienced at least 8 ovulatory cycles with the medication. Also, she received treatment for the endometriosis. Despite receiving treatment for both of these problems, she had not conceived.
Explaining unexplained infertility
A couple has a fertility problem if they have not conceived after 6-12 months of unprotected sex. The diagnostic evaluation for these couples can include a semen analysis, bloodwork, a hysterosalpingogram (HSG), a pelvic sonogram and a diagnostic laparoscopy. If all for these tests are normal, the couple has unexplained infertility. In addition, if something is abnormal and the couple still doesn’t conceive after treatment, then they also have unexplained infertility.
The woman I saw in the office felt that the cause of their fertility problem was her ovulation dysfunction and the endometriosis. However, one could argue if these two problems were the cause, why didn’t she conceive with treatment? Thus, in her situation, there must be something else that is responsible for her infertility. Just because the reason for the infertility has not been discovered does not mean that there is not a reason, but rather that the cause has not be determined by the tests that are currently available.
Despite the fact that couples are really frustrated to hear that they have unexplained infertility, it is important for them to understand that there are procedures available to increase their chances of conceiving. The recommendation for treatment for couples who have had a problem and had it corrected but have not conceived is the same as patients with completely normal tests. These couples have an excellent chance of conceiving with clomiphene/ IUI, Gonadotropin/ IUI, or in vitro fertilization.
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