Unexplained Infertility: Get the treatment in New Delhi

Unexplained Fertility

"What? There is no cause for my inability to conceive? After all those tests you still can't give me any answers?!"

Approximately one in five couples will experience unexplained infertility despite completing a full infertility work-up. The emotional response to hearing, "There is no apparent reason for your infertility" can be difficult and frustrating. Couples who do find out a specific cause find their situations difficult, too, of course, but knowing the "whys" makes it more bearable. In cases of unexplained infertility, couples feel that one reason, one cause is lurking in a shadowy corner. It just hasn't been uncovered yet.

Unfortunately, guilt is one of the pervading feelings. You may feel a sense of guilt individually or collectively as a couple. Some of these guilt feelings may go unspoken because of a previous abortion, because you took so long to even begin trying to have children, or because you are convinced that your anxiety and obsession with your infertility may be the cause of it. As a couple, you may feel different from your infertile friends who know the cause of their problem and are concentrating their efforts and energy on finding the best treatment. You may also feel different because friends and family members can't seem to stop sending you articles about some cutting edge treatment or some new fertility center.

This is what you need to remember: You are doing everything you can, you are seeing the best doctor and you are becoming an educated consumer. Some diseases and medical conditions defy explanation. They just happen. The term "unexplained infertility" really reflects the present limitations of medical science. The fact is that current technology does not have the tools for revealing the cause of your infertility.

It is extremely difficult for those with unexplained infertility to know when to stop looking for a cause, to say "enough is enough." You may feel you are entering a state of limbo. You may feel stuck unable to grieve and get on with other options because you hang on to those slender threads of hope that the cause of your infertility will be revealed in the next test or treatment. Your sadness may intensify as time passes and you find no medical or emotional resolution.

For a significant number of infertile couples, even the experts don’t know why they can't get pregnant. Can new tests help diagnose unexplained infertility?

What Causes Unexplained Infertility?

Unexplained Fertility

Diagnosed infertility in women may be caused by a number of factors. For example, it might be that the egg is not released at the best time for fertilization or that fertilization does not happen at all. Blocked fallopian tubes, uterine fibroids, or uterine problems may also be the cause. Men can also have fertility problems which result in the couple being unable to conceive. Infertility in men is often due to few or no sperm cells being produced. In some cases, the sperm might be misshapen or they might die before they can reach and fertilize the egg.

A woman is more likely to be diagnosed with unexplained infertility if she is 38 or older. As women

get older, the quantity and quality of their eggs diminishes. Most women over 40 have a hard time conceiving, and women over age 44 are rarely fertile even if they ovulate regularly every month. Since there is no test to check for egg quality or quantity, older women with fertility problems are often diagnosed as having unexplained fertility.

Many standard professional textbooks suggest that Unexplained Infertility (UI) represents the most frequent infertility diagnosis in women, encompassing up to approximately 30% of all cases. Yet, we here, at CHR, are not convinced at all that such a diagnosis actually exists and, even if it did, we believe that unexplained infertility would represent a misnomer that should be changed.

A couple that has been assigned the diagnosis of unexplained infertility (UI) obviously suffers from infertility and has undergone a diagnostic work up that failed to reveal a credible underlying cause for their condition. In other words, the diagnosis of UI is reached by default; it is a negative diagnosis, suggesting that a clinical problem exists but that the probable cause for this problem has remained elusive.

When patients come to us with a presumptive diagnosis of unexplained infertility (UI), we very carefully evaluate them for the following four conditions: (1) Endometriosis; (2) Tubal Disease; (3) Premature Ovarian Aging (POA); and (4) Immunological Infertility. In our experience, we will find evidence for one or mor, of these conditions in an overwhelming majority of cases.

The Diagnosis of Unexplained Infertility

Unexplained Fertility

Female Evaluation

The standard infertility work-up for the female consists of a medical history, a physical examination, a test of blood hormone levels, a test of sperm in the cervical mucus after intercourse (postcoital test), a sample of the endometrial lining in the second half of the cycle (endometrial biopsy) for a progesterone level, an x-ray and ultra sound of the uterus and fallopian tubes, ovaries, and laproscopy/hysteroscopy of pelvis, and to look for endometriosis (a condition where endometrial tissue has implanted in various spots throughout the pelvis) and pelvic adhesions (scar tissue).

The Diagnosis is termed unexplained infertility if conditions impeding the woman’s ability to conceive, such as pelvic adhesions, bubal blockage or hormonal problems , are excluded after all of these tests have been performed and the male’s reproductive system is functioning normally.

Male Evaluation

A specialist evaluates the male by obtaining a complete medical history, physical examination, and a semen analysis. Hormonal testing is performed as deemed necessary. Problems that can be detected after this initial evaluation include varicocele, obstruction (partial or complete), hormonal problems, ejaculatory dysfunction, and infection. Unexplained infertility is diagnosed only when the entire male partner’s evaluation is normal, including the semen analysis, However, antisperm antibody testing should also be performed to rule out an autoimmune problem before establishing this diagnosis.

The Chances for Pregnancy in Unexplained Infertility Over time there is a significant spontaneous pregnancy rate in couples with unexplained infertility. This spontaneous pregnancy rate depends on the man’s sperm count and the woman’s age. The spontaneous pregnancy rate may be even higher in patients who have had a previous pregnancy and are diagnosed with what is termed secondary infertility.

Treatments for unexplained infertility are directed toward increasing the chance of achieving a pregnancy by increasing the number of eggs and sperm and by getting the eggs and sperm closer to each other.

The Treatment of Unexplained Infertility

Intrauterine Insemination (IUI)

‘Intrauterine insemination (IUI) with the male’s sperm is one possible treatment choice. IUI increases the number of motile sperm in the woman’s fallopian tube(s) during the time of spontaneous ovulation.

Clomiphene Citrate / Letrozole and IUI

Clomiphene citrate /Letrozole is often given to the female to facilitate ovulation. The combination of clomiphene /Letrozole and IUI enhance fertility. A pregnancy rate of 15 to 20 percent per cycle may be achieved in couples with unexplained infertility, depending upon the age of the female partner. If this approach is not successful within three to four cycles, more advanced reproductive treatments may be advisable.

Gonadotropins and IUI

With follicle stimulating hormone (FSH) or human menopausal gonadotropin (hMG)/IUI therapy, aggressive multiple ovulation induction is performed with injectable medications in order to obtain multiple eggs per cycle. At the time of ovulation, which may be triggered by human chorionic gonadotropin (hCG), IUI is performed to increase the number of sperm in the woman’s fallopian tubes. Multiple studies have shown between a 20 to 25 percent per cycle pregnancy rate using this technique for couples with unexplained infertility where the female partner is younger than 35 years of age. It is often the first advanced therapy chosen for unexplained infertility.

In Vitro Fertilization

In vitro fertilization (ivf) is increasingly utilized in the treatment of unexplained infertility. The goal of ivf is to increase the number of sperm and eggs in direct proximity to each other, thus increasing the chances of a successful fertilization. At times, a clearer reason for the cause of unexplained infertility is discovered during IVF. Some couples may have poor or absent fertilization in vitro (outside the body), thus suggesting a sperm and/or egg problem as a cause for infertility.

PSYCHOLOGICAL SUPPORT

Infertility is a difficult experience under the best of circumstances. The cyclical nature of testing and treatment can be physically, emotionally, and financially exhausting . when no cause can be found as to why conception has not occurred, infertility may feel like a roller coaster ride as each new test and treatment brings hope, and possibly, disappointment. To help with the stress, couples may want to find ways to communicate their feelings with others who understand, such as caring family or friends, or other couples.



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