What Are Your Options?
If you’re under 35 years old and have been trying to conceive for a year, or you’re over 35 and have been trying for six months without getting pregnant, you should consider consulting a fertility specialist. The reproductive endocrinologist will test both you and your partner (if you have a male partner) to determine what is causing your fertility problems.
In most cases the results of the fertility tests will point to a medical cause for infertility. But in up to 20 percent of couples test results will be normal even though they have not been able to conceive, according to the American Society for Reproductive Medicine (ASRM.) They are diagnosed with unexplained infertility, or idiopathic infertility, as it is also known.
If you’ve been diagnosed with unexplained infertility, what are your options?
In order to be diagnosed with unexplained infertility, you have to undergo a complete infertility investigation which includes a semen analysis, ovarian reserve tests, tests to confirm ovulation, and a hysterosalpingogram (x-ray of the uterus and fallopian tubes to rule out a tubal blockage). There are other tests which can be performed but have not been proven to affect successful fertility treatment. For instance, some doctors perform laparoscopy, which has to be done under general anesthesia, to look for signs of endometriosis, when cells from the uterus grow on other organs, or to identify and remove scar tissue that may interfere with the function of the fallopian tubes. However, since in most cases only mild endometriosis will be found in the absence of any symptoms or ultrasound findings, most doctors will not perform a diagnostic laparoscopy and will avoid surgery and treat the patient for unexplained infertility.
Give It Some Time
If you are under 35 years old and your male partner does not have fertility issues, your first choice may be to just keep trying on your own. It’s frustrating to hear that there is no diagnosis and no clear path for treatment. However, about 10 to 25% of couples under age 35 who have been trying for at least 1 year to get pregnant will conceive if they try natural conception for another year. For women over 35, the chances are lower and it makes sense to undergo fertility treatments rather than continue to try on their own. Ask your doctor if continued attempts at natural conception make sense for you.
Other Fertility Treatment Options
Once it is decided that it is time to start fertility treatments, your fertility specialist may talk to you about treatment with clomiphene citrate or letrozole, oral fertility drugs which help your ovaries produce more eggs, and IUI, or gonadotropin shots and IUI. Another option with a higher success rate is IVF. If IUI with oral fertility drugs are unsuccessful, some studies have found that moving directly to IVF is more cost-effective to the patient and results in pregnancy sooner than multiple rounds of gonadotropin shots and IUI because of the higher success rate of IVF. IVF has a success rate of as high as 40 percent per cycle, depending on age, while gonadotropin shots and IUI have about a 10 percent success rate. IVF may also be more able to avoid triplet or even twin pregnancies which are high risk pregnancies.