Unexplained Infertility

The molecular basis of reproduction is not fully understood today. Hence, many couples, with normal basic investigations, are labeled as having unexplained Infertility.

Primary tests in an infertile couple consist of semen analysis, transvaginal ultrasound, hystero laparoscopy and a detailed history.

Despite all above tests being normal, some coupes may have hidden genetic problems, subclinical infection (infection which may not have detectable symptoms) in the endometrium (lining of the uterus) or semen, immunological problems (body’s immune system wrongly rejecting the embryo on the basis that it is a foreign body) that reject embryo implantation.

When taking patient history, a family history of infertility could be indicative of a genetic cause for infertility. Sympts such When examining a patient clinically, we look at sumpyom such as evening rise of temperature or pain in lower back, point to a possible subclinical infection. If all factors are normal, but infertility persists, then it may point to immunological problems.

Unexplained infertility couples can be genetically tested by NGS (Next Generation Sequencing), subclinical infections can be diagnosed by metagenomics (checking bacterial DNA in the uterus/semen) – done through the DICE test, and implantation by immune tests for autoimmunity(immunity of the mother) and alloimmunity (immunity of the baby).

When nothing is found, couples of unexplained infertility are treated by superovulation (growing more than 1 follicle by tablets or injections) with IUI for 3 cycles. If this fails, IVF/ICSI is the treatment of choice. Almost 80-90% of couples with unexplained infertility do end up conceiving.