If no abnormalities are found following a complete infertility workup, the couple is considered to have unexplained infertility. It is important to realize that in this situation, treatment is not geared to correct a problem since none were found. Instead, treatment is geared towards accelerating the time to pregnancy. Couples are reminded that they could still become pregnant at any time without treatment. However, we cannot predict if this would occur within two months or if the couple would still not be pregnant three years later. Therefore, most couples opt for treatment with this diagnosis.
There are two main principles of treatment that must be applied together to optimize success rates. Studies have indicated that using either one of these principles separately to treat unexplained infertility does not improve chances for conception.
- Increase the number of eggs using fertility shots or pills. Each egg has an independent chance to be fertilized and subsequently produce a pregnancy. If more eggs are produced in one cycle, the chances for pregnancy in that individual cycle increase.
- Place sperm and egg closer together by using IUI or IVF. After ejaculation, millions of sperm are normally present in the vagina. However, much smaller numbers reach the egg. By placing more sperm in close proximity to more eggs after using fertility drugs, the odds for conception in that cycle increase.
Monthly pregnancy rates for a normal couple trying to conceive is about 20 to 25 percent. The possible treatment options are listed below with generalized success rates in women younger than 35. Typically, a maximum of three to four cycles of a given treatment are recommended before moving to the next step, although couples have the option of moving to the next treatment step before completing the maximum number of cycles.
- Clomiphene Citrate (Fertility Pill) + IUI Pregnancy Rate/Cycle 15%
- Gonadotropins (Fertility Shots) + IUI Pregnancy Rate/Cycle 18-20%
- Gonadotropins (Fertility Shots) + IVF Pregnancy Rate/Egg Retrieval 40-50%
Typical Treatment Algorithm