Unexplained Infertility - Expect Good Outcomes!
Unexplained infertility implies that a couple has had a normal basic infertility evaluation including a normal assessment of the uterus and fallopian tubes, confirmation of ovulation, and a normal semen analysis. While couples struggle to understand and deal with unexplained infertility, from a therapeutic perspective excellent success rates are possible when a carefully thought out and executed treatment plan is followed. The initial approach which has been carefully studied in large groups of couples with unexplained infertility involves the use of ovulation stimulating medications in conjunction with careful monitoring of the response to these medications and finally precisely timed placement of sperm in the uterine cavity (intra-uterine insemination). This approach overdrives the ovulation process increasing estrogen and progesterone levels and often increases the number of eggs available for fertilization. In this way it tends to overcome minor ovulatory abnormalities which would be very tedious to specifically identify. Tracking of the ovulation process should eliminate any timing issues. The preparation of sperm in the laboratory extracts a population of sperm which tend to be more motile and concentrates them in a small volume of fluid (culture media) which supports sperm metabolism. Placement of highly concentrated and selected sperm high in the uterine cavity has the theoretical advantage of getting greater numbers of “normal” sperm into a position very close to the fallopian tube where fertilization occurs. In some situations it may even be possible to place the insemination catheter directly at the opening of the fallopian tube on the side where ovulation is occurring in that particular cycle delivering even greater numbers of sperm to the site of fertilization.
Ovulation stimulation with oral medication is usually attempted as the first line of treatment. However, when this approach fails, many studies have shown that the use of injectable medications (gonadotropins) also in conjunction with intrauterine insemination, offers excellent prospects for success. In the context of unexplained infertility it is very important to achieve the release of more than one egg in each treatment cycle in order to maximize success rates.
When oral medications and injectable medications coupled with intra-uterine insemination fail to result in successful pregnancy, in-vitro fertilization remains a powerful and highly effective treatment option for couples with unexplained infertility. In-vitro fertilization addresses the greatest number of potential causes for unexplained infertility including male problems, endometriosis, scar tissue, and ovulation disorders. The “per-cycle” live birth rates applying in-vitro fertilization to treat unexplained infertility vary by age with the best success being achieved in patients under 35 years of age. In this age group live birth rates of 45-55% per treatment cycle are commonly achieved in most well run IVF programs.http://www.louismanara.com/services/unexplained-infertility
