The Mysteries of Missing Planes and Unexplained Infertility
by John Storment, MD
Humans are obsessed with mysteries. We want to explain the unknown, the unsolved. By nature we want to be in control of our world, and ambiguities and vagueness challenge that need for control.
The world’s obsession with the plight of the missing Malaysian airliner has had me thinking about mysteries, in general. The unknown and the inability to explain something strikes a chord with our human nature. The disappearance of Flight 370 is a real whodunnit unfolding live before our very eyes. Adding to the fascination is certainly the fact that a genuine mystery would seem impossible in our hyper-connected, technology-driven day and age.
The same can be said for unexplained infertility in my profession. How is it that with our modern-day tests and technology we cannot pinpoint what could possibly be preventing that egg and sperm from meeting up in our bodies to begin creation of another human being? How is it that there are still so many mysteries surrounding the human body? Why can’t we control our bodies to do what we want?
Unexplained infertility is still a mystery
Unexplained infertility occurs in about 15-20% percent of couples who come in to my office. It is a hard diagnosis for many of my patients to swallow. How can it be that we just don’t know? After the work-up and evaluation are completed, why is it that their problem in conceiving cannot be determined?
Unexplained infertility simply means that we do not know why the couple is not fertile. People with unexplained infertility do have a cause for their infertility, but due to limitations of our current testing, we cannot determine the reason.
The diagnosis is one of exclusion-that is, one that is made only after all the tests have been performed and their results found to be normal. Infertility may be labeled as “unexplained” when:
- the woman is ovulating regularly, has open fallopian tubes with no evidence of adhesions or endometriosis;
- the man has normal sperm production;
- sexual intercourse takes place frequently, particularly around the time of ovulation; and,
- the couple has been trying to conceive for at least one year
Optimization of chance is the treatment goal for unexplained infertility
Because unexplained infertility carries no specific diagnosis, the treatment I typically recommend is empiric. This means that the treatment is done to optimize a couple’s chance of successful conception but is not used to treat or overcome a specific problem. Sometimes the diagnosis is simply not as straightforward or easy to diagnose. Instead of spending valuable time on testing, it is sometimes more efficient to treat subtle defects of ovulation or sperm function with medication combined with intrauterine inseminations.
In some instances, couples with unexplained infertility will conceive over time with no treatment. In fact, 50% of couples diagnosed with unexplained infertility, who have never had a child before, will conceive within five-and-a-half years. For those couples wishing to expedite this process and not simply wait, there are proven methods to increase the chance of pregnancy even when no specific diagnosis can be made.