Unexplained Infertility
February 02, 2018

Patients with unexplained infertility often find it very difficult to accept this diagnosis, and their commonest plaint is - I wish I knew why I wasn't getting pregnant. They are also not sure how to proceed - After all, if the doctor cannot find out what the problem is , how will he be able to fix it ?

Unfortunately, they are so focused on trying to find out what the problem is they often get paralysed into inactivity . Since they do not get any clear answers , they keep on doctor shopping. This increases the confusion, because they get widely varying opinions and treatment options, so that they don't know what to do next. ( By contrast, for a woman with damaged , blocked tubes, the absence of alternatives makes decisions making easier ! They only have 3 choices - remain child-free; adopt; or do IVF - In Vitro Fertilization).

Unfortunately people get so obsessed with diagnosing problems so that they can fix them, that they end up doing a zillion investigations, and identifying millions of minor irrelevant problems, which have no bearing on the fertility problem. However, they concentrate their energies on correcting these so called problems ( whether it's pus cells in the semen; minimal endometriosis; high levels of NK cells , an abnormal SCSA result, or whatever) that they lose sight of the important goal, which is a baby ! It's important to focus your energies on your goal, so you don't waste time and energy or irrelevancies.

It is interesting to see how fashions in medical science also change with regard to these patients . For example , many years ago , the diagnosis of luteal phase defect was very commonly invoked, and this was a very popular diagnosis to explain the infertility in some of these couples and many investigation protocols and treatment protocols were also designed to treat this problem . After all, doctors , just like patients, are happier when they have a name to put on a particular disease .

The problem with treating unexplained infertility is that anything can work , which is why there are so many anecdotal successes with all forms of treatment. Since infertile couples are emotionally very vulnerable , they are often willing to try any treatment fad , in the hope that it'll work for them.

Also since everything is normal , many of these couples are hell-bent on achieving a natural pregnancy in their own bedroom. After all if everything is normal , then there really is no reason why they can't get pregnant in their own bedroom, is there ? And all of us have heard success stories of people who have conceived after ten to fifteen years of trying . Unfortunately , these couples often end up wasting a lot of precious time . The fact remains that if people haven't got pregnant in their own bedroom within three years of trying , the chances of their conceiving on their own are very low. It is no longer cost effective or time effective for them to keep on waiting , because they pay a price for this waiting - and the price they pay is a loss of their reproductive potential. This often means that by the time they seek infertility treatment , there is little an infertility specialist can offer them .

I always remind my patients with unexplained infertility that the quality of the answer depends on the quality of the question , and the question should NOT be - Why am I not getting pregnant ? After all , no one cares about problems - people only care about solutions ! The right question is - What can I do in order to get pregnant ? Rather than waste time and money on irrelevant tests , it's important to formulate a treatment plan of action to maximize the chances of success . Never do a test or investigation if it does not change your treatment plan !

The good news is that even though our medical technology for diagnosing problems in the area of infertility is not very good , our technology for solving them today is brilliant .

This is the reason why IVF - In Vitro Fertilization is such an effective treatment option for patients with unexplained infertility - it allows us to bypass all the possible barriers to the eggs and sperm meeting within the human body - even if we cannot name these barriers , or come to an accurate diagnosis in the individual patient. I remind my patients that IVF allows us to do in the lab what should normally have happened in their bedroom , and is not happening because Nature has let them down . We still may not be able to pinpoint where Nature has let them down , but once they have a baby in their hands , this then becomes a question of merely academic interest .

This success-oriented approach to infertility means we need to turn the conventional medical principle of making a diagnosis and then deciding the correct treatment upside down, but it's easier to understand this approach by looking at a simple analogy. Suppose you want to go from Boston to New York, and your car breaks down half-way. One option is to take the car to the garage , let the mechanic diagnose the problem, and then let him fix it. The other option, which is much better if you are in a hurry, is to just take another car and drive it down to New York. The important this is to reach New York - how you get there is really not important ! Similarly, as long as IVF allows us to bypass the medical problem ( even if we don't know what the problem is and we can't put a name to it), and allows patients to get the baby they want, then it makes much more sense to go in for IVF, rather than waste time on testing , and fixing minor and often irrelevant problems.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.