WHAT IS UNEXPLAINED INFERTILITY?
Unexplained infertility is a term offered by medical professionals who aren’t able to link a couple’s infertility to a known cause. Too often than less it is used as a catch-all classification, leaving couples who are seeking answers for their infertility questions feeling frustrated, helpless and uncertain.
To be diagnosed with unexplained infertility, couples under the age of 35 must attempt to become pregnant after at least 12 months of unprotected sex. If couples are over the age of 35, the period of time for which a couple attempts to become pregnant after unprotected sex is slightly shorter (6 months) for the same diagnosis. In addition, both partners must fail to be diagnosed for any known causes of infertility.
The American Society for Reproductive Medicine (ASRM) defines infertility as the result of a disease of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery. Standard diagnostic tests for known causes of disease of the male or female reproductive tracts typically target:
- Ovarian reserve testing
- Verifying ovulation
- Semen analysis
- Hormone blood test panels
- Abnormal reproductive organs
When it comes to unexplained infertility, the diagnosis is typically made after such infertility tests show normal results. However, researchers have argued that the basis for the diagnosis is subjective. This is because differences exist among what medical professionals consider as a complete infertility evaluation to conclude unexplained infertility. Such disparities could potentially cause misdiagnosis and incite failure to investigate other principle causes of infertility, ultimately resulting in inconsistent and ineffective treatments prescribed.
It’s important to point out that coming to a conclusion about a specific infertility diagnosis could require extensive efforts and investment of resources from both medical professionals and the couple. For example, other contributing infertility causes present in a couple that are otherwise unknown to medical team can contribute to multifactorial infertility, further complicating diagnosis. It is up to couple to precisely reflect on their current (and past) state of health and be forthcoming with details that fully represent their health history so that an accurate assessment could be made by medical professionals.
Nevertheless, such extensive efforts and resources for investigating principle causes of unexplained infertility are limited in many fertility clinics. Consequentially, couples are too often offered the catch-all classification of unexplained infertility and subject to otherwise generalized treatment protocols.
Does it matter if infertility is explained or unexplained?
Scientists have argued that unexplained infertility is unsustainable as an independent diagnosis and should be otherwise abandoned. In fact, having a catch-all term to define an absence of specific diagnostic findings is indeed fundamentally useless in helping couples become pregnant. It does not define a specific treatment plan for the couple, rather it adversely requires additional efforts to reach an infertility diagnosis more accurately.
Alternatively, one could argue that an unexplained infertility diagnosis is not without value because it can uncover underlying health issues – those that are typically unrecognized by couples who are under the assumption that they are in a good state of health. After ruling out any known causes of disease to the male and female reproductive tracts using standard tests, the couple may shift their focus to other factors that indirectly cause infertility. Several studies have linked infertility to other principle causes that are often missed in standard diagnostic tests, such as immunological issues, endometriosis, prematurely aging ovaries and other underlying health conditions.
When it comes to clinical treatment options, management of unexplained infertility cases are unlikely to be different in terms of assisted reproductive technology (ART). While having identified an infertility cause may certainly increase the efficacy of treatment options, many fertility clinics often offer the same ART treatment options for couples regardless of whether infertility is explained or unexplained.
When it comes to a holistic or functional medicine approach, the homeostatic state of the whole body is considered. Couples may uncover potential imbalances in other areas of the body that affect their current state of health, investigate how those could be impacting their infertility and explore interventions they may put in place to improve their fertility. An example of this would be blood sugar imbalance in the mother-to-be that impacts levels of reproductive hormones, all of which can be managed with lifestyle shifts.
Ultimately, a more accurate diagnosis could help patients reach their pregnancy goals sooner but this could require conventional clinical teams to work collaboratively with other health professionals such as functional medical teams, certified nutritionists and/or health coaches. Prescribing tailored treatment options, recommending necessary lifestyle shifts and remedies to promote natural fertility can be far more effective than a generalized treatment approach for infertility cases.
Should the definition of infertility be reconsidered?
Functional medicine attributes infertility to a greater imbalance present within the body, often integrated within multiple systems and not limited to disease of the male or female reproductive tract. So why do conventional clinical teams only focus on disease of the male and female reproductive tracts?
Our bodies are advanced systems that rely on a multitude of chemical processes for us to function in an optimal homeostatic state. Those processes are integrated amongst one another – deficiencies in nutrients or excessiveness of toxins for a particular process can disrupt the homeostatic balance and cascade adverse effects elsewhere in the body, including to our reproductive capability.
Several studies have linked diet and lifestyle factors to cause hormonal imbalances, many of which or responsible for causing infertility in women but can be corrected for before visiting an infertility clinic. Infertility doesn’t have to be a permanent and there are ways to improve your fertility and get pregnant naturally. In fact, infertility is a call to action in taking back accountability to sustain our long-term health and wellbeing. Whether its explained or unexplained, the definition of infertility should account for the underlying issues rooted outside of the male or female reproductive tracts, those which must be addressed first.