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What is Unexplained Infertility?

What doctors call “Unexplained infertility” usually turns out to be a perfectly explainable condition that was missed in initial tests. Low ovarian reserve, which varies by age and can be very subtle, is a frequent culprit of previously “unexplained” infertility.

Many couples come to us believing that they have something called unexplained infertility. Well, it’s only natural that everything is unexplained unless you make the effort to try to and explain it. So until you begin an investigation you are unexplained. The traditional fertility investigation looks at a semen analysis, maybe a few blood tests, looks at ovarian function and tubes, to see if the tubes are open. If those three first level tests appear to be normal, they said we don’t know why you’re not getting pregnant, you have unexplained infertility.

Over the years CHR has taken a closer look at each of these issues and for many people who have come to us with unexplained infertility, we found they had something we call low functional ovarian reserve. It was undetected because ovarian reserve is different at different ages. If you make an arbitrary single cut off for laboratory parameters of ovarian reserve, you may look, you may say oh she’s normal. However, if you’re working with someone who’s thirty or thirty-one years old and if they have a level of a thirty-eight year old, she already potentially has a problem.

Similarly, there can be some fine changes in the way one looks at a semen analysis that can help to explain these things. There can be assorted immunological problems that can help to explain problems with ovarian reserve, and we’ve been carefully trying to sort out each of these things. I’m happy to say it’s very unusual for us to be taking care of a couple that we don’t have a pretty firm idea about some of the problems that they are experiencing.