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Treatment Of Unexplained Infertility

The treatment of unexplained infertility involves ruling out as many potential causes as possible to identify, testing the most likely suspects and focusing on improving health to raise fertility. Couples with unexplained infertility will have been trying to conceive for at least a year before further tests or treatments are usually considered. This approach is based on the couple being able to have natural pregnancies because the woman has: i

  • Healthy womb structure
  • Healthy “patent” Fallopian tubes
  • Regular ovulation

And the man has:

  • Has enough healthy-looking sperm
  • Is able to have penetrative sex

When couples are told they have “unexplained infertility” there are generally two reactions to the diagnosis:

  1. Continue trying knowing there aren’t any obvious blocks to pregnancy
  2. Seek medical intervention to increase the chances of conceiving

Standard treatments

When couples choose medical intervention, the approach tends to follow a standard rather than a personalised framework:

  1. The woman has a course of clomiphene citrate (Clomid) for three to six menstrual cycles to induce ovulation (even if there are no ovulation issues). Clomid isn’t always recommended for women over 35 as it reduces the thickness of the womb lining, and a thin womb lining prevents implantation. Older women tend to have thinner womb linings anyway, and Clomid is generally most successful for younger women with a normal or higher BMI.
  2. IUI (intrauterine insemination) is usually the second treatment option and it’s often combined with Clomid. IUI can remove any hidden problems where sperm and mucus are incompatible, which is something that’s an issue for about 20% of infertility cases.
  3. The third option is to have several (usually 3) IVF cycle treatments. ii

Alternative approaches

An alternative option is to maximise the chances of conceiving each month by following the advice within the six morefertile® Personal Fertility Profiles. We also strongly recommend reading these articles:

The site also contains excellent information explaining:

  • How to spot when you’re most likely to conceive
  • The impact of lifestyle on fertility
  • How stress is a significant player, and how to manage it
  • Treatments for specific conditions and how herbs help unexplained infertility

Herbal medicine

Research suggests that combining IVF or IUI with herbal medicine significantly increases success rates, and a herbal/ IUI combination had a 65.5% conception rate, compared with 39.4% in the IUI group. iv

Herbal medicine has a different diagnostic framework to recognise patterns and provide personalised treatment options. It’s effective at improving general health and raising sexual function, with research showing it increases: v

  • How many follicles reach the last stage of development
  • The size of Dominant follicles
  • The thickness of the womb lining after ovulation
  • Blood flow in the corpus luteum
  • Progesterone levels in the luteal phase
  • Blood flow in the uterine artery
  • Pregnancy rates

It also reduces:

  • FSH levels at the start of cycles
  • Immune function irregularities

Additional Tests

When the standard tests can’t find anything that prevents pregnancy, it becomes more appropriate to consider tests that go “above and beyond” the standard tests. Some of these tests are specialist and difficult to access, but others are very accessible:

Tests for men

Further testing for men involves specialised sperm analysis to assess sperm’s ability to fertilise eggs and maintain viable pregnancies:

Tests for women

Women should have had all the standard tests for infertility, but the availability varies. In an ideal world, women with unexplained infertility have:

  1. Blood tests for sex hormones and to check the status of her ovarian reserve.
  2. Laparoscopy to look for endometriosis, even when there aren’t any symptoms of endometriosis. Endometriosis significantly impacts fertility, but laparoscopy is not always part of fertility testing.
  3. Altered immune status checks are difficult to access. However, immune disorders are believed to be a significant, hidden cause of infertility. They require blood or tissue samples, and more information is on immune issues.
  4. Thyroid testing (that includes T3 levels) is something all women should have, and both clinical and subclinical hypothyroidism can affect fertility. Saliva samples can be used for testing, and supplementing may be enough to regain full thyroid function.
  5. Abnormal womb structures can be missed up to ¼ of the time when part of the initial fertility “work-up”. 25% is a large percentage and makes having a hysteroscopy to re-check the uterus a good idea. vi
  6. Thrombophilia is a significant player in miscarriage and infertility, so women need to have blood tests to exclude this factor.
  7. Bacterial vaginosis is present in a surprisingly high percentage of women and contributes to unexplained infertility. Simple tests and treatment options are available, and the microbiome of the vagina and gut are closely connected. A healthy diet and probiotics encourage microbiome health throughout the body.
  8. Make sure your diet is balanced and contains enough folate for a baby to develop normally.
  9. Avoid toxins and lifestyle choices that increase oxidative stress and reduce the chances of a healthy pregnancy.
  10. Consider treatments like herbs, acupuncture or massage to improve your chances of conceiving.

i ‘Future evaluation and treatment of unexplained infertility’ Michael P. Diamond, June 2016. Volume 105, FertStert. Issue 6, Pages 1457–1458
ii “A randomised clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial”. Reindollar, R. H. et al. (2010) Fertility and Sterility 94 (3): 888
iii http://www.thehorse.com/ViewArticle.aspx?ID=19730
iv http://www.eurekalert.org/pub_releases/2012-01/afot-emw010912.php
v ‘Measuring the effectiveness of Chinese herbal medicine in improving female fertility.’ Trevor Wing and Elke Sedmeier. Journal of Chinese Medicine. 80. Feb. 2006. 22-28
vi Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. Reprod Biomed Online May 2004;8(5):590-94
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