Explaining unexplained fertility issues

New Delhi

Infertility is a condition marked by the inability to conceive a child even after a year of trying. This can be due to a variety of reasons, depending upon which the treatment plan is tailored, points out Dr. Shweta Goswami, Associate Director- Fertility, Cloudnine Group of Hospitals.

However, in some cases, it is not possible to determine the exact cause, she tells IANSlife. "This means that the basic tests of infertility do not show any specific tests that can be held accountable for your inability to start your journey towards parenthood. You will be surprised to know that 1 in 10 cases of infertility is that of unexplained infertility. Though the reason is not known, it does not mean that the problem has to be neglected or has no solution. In fact, in around 50 per cent of the cases, the problem resolves on its own within a year of the diagnosis and the couple is able to conceive naturally. However, in some cases, the problem might even aggravate. This makes it important to seek immediate medical intervention and go for proper screening.

Usually, women are recommended to go for fertility tests like ultrasound to check whether the ovaries and uterus are fine and tubal potency tests like sonosalpingography (SSG) and hysterosalpingography (HSG) to detect any abnormalities or blockage in the fallopian tubes. Males, on the other hand, are recommended to go for procedures like semen analysis to evaluate the quality of their sperm. Various factors like the age of both the partners and how long they have been trying to have a baby also contribute to this. However, in the case of unexplained infertility, all the tests reports are normal. Though the abnormalities are present, they remain undetected," she says.

Women above 30 years of age, who haven't been pregnant before and are trying to conceive for more than three years unsuccessfully are more likely to be detected with unexplained infertility.

Dr Goswami says unexplained infertility is majorly a result of any of the following:

Poor egg quality or lower ovarian reserve - This can be determined by performing AMH or anti-mullerian hormone test. AMH hormone is a hormone produced by the ovarian follicles and acts as a marker of the egg quantity. It is possible for a woman to be completely healthy, yet have a weaker result in AMH test. Even if the result is normal, the women may have alleviated egg quality. It is quite difficult to determine the same as there are only limited basic tests available.

Dysfunctional fallopian tubes - Although tests like sonosalpingography (SSG) and hysterosalpingography (HSG) help to detect any sort of blockage in the fallopian tubes, there is, by far, no such test that can help to determine whether the fallopian tubes are carrying their function normally. It is possible to have functional abnormalities despite having normal HSG and SSG reports. In this case, we do not know if the egg is able to enter the tube or not. This is something that an ultrasound or any other imaging modality might not be able to access.

Sperm defects - Though other sperm parameters like sperm quality, quantity and motility may be normal, the sperm may not be able to fertilize the egg well or there may be sperm DNA damage which is preventing normal fertilization. Here, we are not looking at poor sperm quality but rather poor fertilization.