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Unexplained Infertility
It is not always possible to find a cause for a couple’s infertility. This is perhaps the most frustrating “diagnosis” because no specific “abnormality” can be targeted for treatment. We consider the couple as “unexplained” when we have the following situation:
-Normal, ovulatory cycles
-Normal semen analysis
-Normal hysterosalpingogram (HSG)
-Negative history for pelvic scar tissue or endometriosis
Even in cases of unexplained infertility, there is a “cause”, but science has not advanced to the point where it can be identified. As new research is conducted, the number of couples in the “unexplained category” should diminish.
Most authorities believe that a large segment of unexplained infertility may be due to failed fertilization or subtle damage to the fallopian tubes. There could be sperm abnormalities leading to poor fertilization or “errors” when the gametes (egg and sperm) combine to form the embryo. This is seen in many cases of recurrent miscarriage since many of the embryos in these couples exhibit an abnormal number of chromosomes (aneuploidy). There could also be other genetic abnormalities that have yet to be determined. In normal situations, the fallopian tube picks up the egg and nurtures it until it is fertilized. Many women may have undiagnosed tubal infections that lead to faulty tubal function.
Intrauterine insemination (IUI) (offered by our North Carolina fertility clinic) in combination with fertility drugs is sometimes the treatment of choice for unexplained infertility, dependent upon many factors including female age and previous treatment history. Couples who conceive generally do so in the first six treatment cycles, so six cycles of IUI may be tried before progressing to more advanced therapy such as in vitro fertilization (IVF). In some cases, IVF is the best “first line” treatment especially if the female is over 35, if male infertility is present, or if there is no insurance coverage and the patient desires to optimize her money towards the most effective treatment (i.e. IVF).
One major advantage of IVF is that it allows the embryologist and physician to view and document fertilization and then place the embryos into the uterus where one will hopefully implant. Sometimes the embryo will not implant into the endometrium. In these cases, assisted hatching may be used to help the embryo “break free” of its surrounding membrane, the zona pellucida.
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