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Unexplained Infertility

Unexplained infertility is the diagnosis almost a third of couples who go to fertility clinics receive i after they’ve had a wide range of fertility tests. To be told at the end of this “we don’t know” is distressing and frustrating. In an ideal world, the “fertility work-up” involves laparoscopy to check for endometriosis (or other problems), but this level of testing isn’t available everywhere.

This means that known causes of infertility are often undiagnosed simply because access to complete testing is limited for many people. Age is an essential factor for both sexes, and women over 37 are diagnosed with “unexplained infertility” over 50% of the time. ii

“Unexplained infertility” isn’t really a diagnosis, but what it means is:

  • infertility means the couple has been actively trying to conceive for two years
  • unexplained means usual tests haven’t found a cause to explain why they’ve not conceived


Without a clear diagnosis, it’s difficult to see an obvious route forward, which can easily turn into a life crisis for the couple, who are usually told to either:

  1. “Go home, relax and keep trying”
  2. “Look at making some lifestyle changes”
  3. “Think about having assisted reproductive techniques (ART)”

A diagnosis of unexplained infertility suggests that none of the usual causes of infertility is likely to be overriding issues. The situation is usually that things are working, but not so severely they show up in a test. It’s crucial to remember infertility doesn’t mean sterility, and most infertile couples (55%) get pregnant in the next 36 months of trying. iii

Low fertility is something that many couples unknowingly have yet they still have babies with little or no problem. The WHO semen sample references are helpful when explaining variations of fertility. All the men in the WHO group were fathers that year, but the semen from 5% of them was officially infertile. While the average monthly conception rate is 20%, a few super-fertile women have rates of 60%. For the couples who have low monthly rates, they need to make sure everything is working in their favour to get pregnant.

Age and unexplained infertility

Age is a crucial issue when trying to get pregnant, as it has a clear and predictable effect on the fertility of both partners. Is the age factor fully appreciated when 50% of women over 37 are diagnosed with “unexplained infertility”? Monthly pregnancy rates fall as we get older, so it makes sense that the timeframe for essentially a non-diagnosis of “unexplained”‘ should be later than the standard two years. Without factoring in the impact of age, the diagnosis rate gets higher as couples reach their later 30s and early 40s. Age is a factor, and it does reduce conception rates and carries associated risks. There are also multiple options to improve the fertility of older couples by addressing their personal fertility. These options are part of the morefertile Personal Fertility Profile support packages.

Health and unexplained infertility

The impact of health conditions and lifestyle on fertility is also pretty much ignored despite solid evidence showing how important it is for couples. These crucial considerations could also change the diagnosis and the approach to the situation. Couples diagnosed with unexplained infertility tend to be offered a standard option of ART irrespective of age or health status. However, this may not be the best one for their finances, their health or the outcome.

Many things can reduce fertility without necessarily stopping it, and there are tests for some, but not all of them. We fully explore the risk factors and causes of unexplained infertility, as well as the treatments and further tests that are available. Having a bit more control of the situation is something that helps, and problem-solving the possible causes of unexplained pregnancy in a step-by-step way can rule out a lot of potential issues.

Complementary approaches

Some apparently unimportant issues significantly affect fertility, and the chances of getting pregnant fall to 25% of the norm when a woman’s cycle lengths vary by ten or more days in a year.iv A variety of treatments improve hormonal balance and cycle regularity. Medicinal herbal combinations can double the chances of conception for couples with unexplained infertility in just three to four months compared to standard IVF. v We strongly recommend all couples follow the advice for their PFP to increase the chances of conceiving and having a healthy baby.

i https://www.hfea.gov.uk/treatments/explore-all-treatments/in-vitro-fertilisation-ivf/
ii Edgardo Somigliana, Alessio Paffoni, Andrea Busnelli, Francesca Filippi, Luca Pagliardini, Paola Vigano, Paolo Vercellini; Age-related infertility and unexplained infertility: an intricate clinical dilemma, Human Reproduction, Volume 31, Issue 7, 1 July 2016, Pages 1390–1396, https://doi.org/10.1093/humrep/dew066
iiiDefinition and prevalence of subfertility and infertility. C. Gnoth et al. Hum. Reprod. (May 2005) 20(5):1144-1147 first published online March 31, 2005 doi:10.1093/humrep/deh870
ivMenstrual cycle pattern and fertility: a prospective follow-up study of pregnancy and early embryonal loss in 295 couples who were planning their first pregnancy. Henrik A. Kolstad et al. Fert& Ster. Vol. 71, No. 3, March 1999
v Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: A systematic review. K. Ried, K. Stuart. Complementary Therapies in Medicine (2011) 19, 319—331
Photo by rajat sarki on Unsplash

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