Hi. My name is Wendy Shelly. I'm boardcertified in obstetrics and gynecology as well as reproductive endocrinology. My focusis in infertility. Today I'm going to spend a little bit of time talking about unexplainedinfertility. This is a diagnosis that people often come to our office with and there isa great deal of misunderstanding about it. First and foremost, I'd like to give the definitionof unexplained infertility. Unexplained infertility is defined as any individual who has had unprotectedintercourse for greater than 1 year with no attributable cause to their lack of conception.When someone comes to me with this diagnosis, I do think it is very important to evaluatethem for any probable cause. When I'm breaking
down my evaluation for unexplained infertility,I tend to look at it from a perspective of 3 components eggs, sperm, and mechanics.To evaluate eggs as a cause of infertility I consider ovulation, egg quantity, and eggquality. To assess for ovulation, we can investigate either with ultrasound or blood work to determinewhether or not ovulation is occurring on a regular basis. Quantity and quality of eggsare a little more difficult to assess. Quantity, in particular, is not something that is availablefor examination with a biologic marker such as a blood test and so we generally base ourevaluation of such a thing with evaluation of your general al history and certainlyprobably most importantly your age. Quantity
however we can assess and we assess that byway of labs such as an AMH level (AntiMullerian hormone), labs like a FSH (follicle stimulatinghormone), and an estradiol level. We can also assess quantity of eggs by performing ultrasoundand specifically looking at the number of antral follicles that sit in the ovary. Thisinformation collectively can give us insight into the function of the ovary and determinewhether or not it may be contributing to the fertility problem.For sperm, we generally recommend at least 1, if not 2, semen analyses. Semen analysiswill give us information about quantity, quality, and morphology of sperm. All 3 of these playa significant role in sperm function and whether
or not we can expect to see a conception underthe usual circumstances. Finally, to evaluate unexplained infertility,I do recommend evaluating the mechanics of getting sperm and egg together. This involvesan evaluation of the uterus and the fallopian tubes. This is often accomplished with anultrasound and a hysterosalpingogram which will examine the patency of fallopian tubes.Once this testing has been performed and we find unremarkable results then someone willtruly carry the diagnosis of unexplained infertility. Now unexplained infertility does not meanthat everything is ok. It simply means that we have reviewed that contributing factorsthat we have the ability to review and are
essentially looking at a picture that is undefined.There are certainly areas of reproduction that we don't know a lot about that likelycontribute to those people that actually fall under the category of unexplained infertility.In particular we do not have a lot of information about egg quality as I alluded to earlier.We also don't have a lot of information these days about the receptivity of the uterus.This is a relatively unstudied area. It is likely some of individuals that fall intothis category of unexplained infertility actually do have something wrong in these areas. Otherindividuals may have very subtle ovulatory dysfunction that is not picked up on our generalscreening test.
Now the good news is if you have been giventhe diagnosis of unexplained infertility it by no means all hope is lost. Generally formost people diagnosed with unexplained infertility, we can achieve your dreams of conception itjust requires a little bit of work. What we typically will do is approach the unexplainedinfertility at all angles trying to optimize at the various points of the reproductiveprocess. We can optimize the ovulatory event. We can consider superovulation to maximizethe number of eggs that are exposed on a per cycle basis. We can perform inseminationsto allow for higher quantity of good quality sperm to be arriving in the right locationaround the time of ovulation. We can even