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Unexplained infertility represents a wide portion of the causes of infertile couples, after a thorough investigation including laparoscopy there is 10-20 % cases of unexplained infertility. There are many factors that might influenced the incidence and management of these cases. One of the most important factor is woman age as there is progressive fertility reduction with advancing age after 35. This reflect the quantity and quality status of the woman eggs. As a matter of fact, there are enormous number of factors that influence fertility starting from the brain through hypothalamic pituitary ovarian axes, fallopian tubes, endometrium, cervix. Each one of these has so many issues that may influence their functionality and patency, that will lead to failure of conception, or early unnoticed miscarriage.
Current investigations deal only with the overt causes of infertility like, the quantity of sperms, ovulation status in general, tubal patency and presence or absence of endometriosis. They don’t tackle the hidden causes of infertility at molecular level.
Tuning a plan to treat a couple with unexplained infertility is a meticulous job, taking in consideration women age and duration of infertility. The chance of pregnancy after 5 years for a couple with unexplained infertility trying on their own is less than 5%.
What do we have in our pouch as physicians to offer for those couple, indeed this aspect of medicine has been developed in the last few decades and witnessed an enormous progress in the management of infertile couples.
Let’s discuss these options and let starts with least interventional and/or invasive, not to forget age, and history factors and trying to optimized the use of time especially for older patients.
Ovarian Stimulation and timed intercourse: this mode of treatment (Clomiphene, recently letrozole) has shown to double the chance of conception in such group of patients.
Ovarian Stimulation and intrauterine insemination IUI: Use of IUI has shown to increase the chance of conception for couples with unexplained infertility. The addition of ovarian stimulation and proper timing much improve the success rate of this modality of treatment. the chance of success is about 10% per cycle with cumulative success rate for three successive cycles.
Injectable Gonadotropins and IUI: has shown to improve success rate compared to placebo or no treatment,
In vitro fertilization (IVF) and other Assisted Reproductive technologies (ART) Has opened a new scope in the treatment of infertility in general and unexplained infertility is not an exception. Excellent results have been achieved in this field especially for younger ladies with good ovarian reserve.
The treatment of unexplained infertility depends on the age of the female partner, her ovarian reserve and the duration of the infertility. In cases were the infertility is not long (under2 years) and the female is young the treatment can be expectant. In case of longer duration the conventional approach is ovulation induction and IUI. In cases of long duration of infertility and women over the age of IVF is recommended. There is no additional benefit of ICSI.
In vitro fertilization (IVF)
Negative Ions is the best Natural treatment for Unexplained Infertility, Poor Ovarian Reserve (for many diseases):
Dr Mira Bajirova “Natural Pregnancy by Negative Ions in Young Woman with Ovarian Poor Reserve after Four Failed IVF”https://www.ecronicon.com/ecgy/pdf/ECGY-SPI-0S103.pdf
Dr Mira Bajirova “Natural Pregnancy by Negative Ions in Young Woman with Premature Menopause”
https://www.ecronicon.com/ecgy/pdf/ECGY-SPI-0S101.pdf
Dr Mira Bajirova Miraculous effects of negative Ions on Male Infertility,
1st I have to meet the couple with full history & age with past history , medical history , is it primary or secondary infertility , duration of infertility then according to situation we can decide together . Generally speaking more than 2 years IVF is preferred .
Following the NICE Guidance on Fertility, Unexplained Infertility(1 in 4 infertility cases or 25%) is one in which all female and male factors of Infertility have been considered to be normal. This includes a thorough work-up, including history, clinical examination and investigations, to check if ovarian factor(ovulation), tubal factor(patency check), uterine or peritoneal factors AND Male factor ( Semen Analysis) have been ruled out and found to be ALL NORMAL, and the couple have fairly tried to conceive Naturally for 2 years.
There is recommendation that in such a case, Ovulation Induction by Clomiphene tablets or Gonadotrophin( hormonal) injections is not indicated. Also role of Intrauterine Insemination (IUI) or ICSI/GIFT is questionable with little evidence.
Evidence based Medicine recommends IVF or In-Vitro Fertilisation(Test-Tube baby, as commonly known) to be offered to the couple.
According to NICE 2013 guidelines, best way to treat unexplained infertility depends on couple's prognosis for pregnancy. If prognosis is good (female age <35 years, short duration of infertility, good ovarian reserve), best way to treat is to allow couple to try naturally till 2 years of trying for conception without intervention. If infertility is of > 2 years & prognosis for pregnancy is not so good, best option is IVF/ICSI.
