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Unexplained infertility (a clinical challenge in reproductive medicine)
Unexplained infertility is defined as the failure to conceive after 12 months of regular, unprotected intercourse, or after 6 months in women over 35 years of age. Despite significant advancements in diagnostic methods, approximately 10-20% of cases remain classified as unexplained infertility, where routine tests for both partners appear normal.
This diagnosis presents a clinical and psychological challenge due to the absence of a clear underlying cause toward which treatment can be directed.
Diagnostic Assessment:
Unexplained infertility is diagnosed after completing basic investigations, which include:
1- Evaluation of ovulation through ultrasound monitoring of follicles.
2- Semen analysis according to World Health Organization standards.
3- Assessment of the patency of the fallopian tubes.
4- Evaluation of the uterine cavity by ultrasound or hysteroscopy, if needed.
When these elements are normal, the diagnosis is based on exclusion.
Possible Pathological Mechanisms:
Despite the absence of a clear defect, studies point to several subtle mechanisms that may explain the condition, including:
- Subtle disturbances in egg quality.
- Subtle sperm dysfunction (DNA fragmentation).
- Disruptions in the interaction between egg and sperm.
- Impregnation.
- Subtle immunological abnormalities.
Some recent research published in journals suggests that a percentage of these cases may be reclassified later with the development of genetic and functional testing techniques.
Treatment Plan:
Management depends on the woman's age and the duration of delayed pregnancy:
1- Expectant Management.
Suitable for women under 35 years of age with a short period of delayed pregnancy.
2- Ovulation Induction with Intrauterine Insemination (IUI).
This is the first-line option in most cases, especially within 3-6 treatment cycles.
3- Intracytoplasmic Sperm Injection (ICSI).
It is recommended in cases where IUI has failed, the wife is over 38 years old, and there has been more than 3 years of infertility.
Data shows that pregnancy rates in this group are often good when IVF is used, suggesting a minor uterine dysfunction that can be overcome through laboratory testing.
Psychological aspects:
Studies indicate that women with unexplained infertility experience higher levels of anxiety compared to those with a clear organic cause, due to the lack of a direct explanation. Therefore, psychological support is an important part of the treatment plan.
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
