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Treatment Of Unexplained Infertility

Unexplained Infertility: Treatments and Further Tests. Couples with unexplained infertility have been trying to conceive for a year or more before further tests or treatments are usually considered. This is based on the woman being able to have a natural pregnancy because she has: i

  • A standard structure to her womb.
  • Healthy “patent” Fallopian tubes.
  • Regular ovulation.

And the man has:

  • Enough healthy-looking sperm.

There are generally two responses to an “unexplained” diagnosis:

  1. Continue trying in the knowledge 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, what tends to happen is a standard rather than a personalised approach:

  1. The woman goes on 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. A thin womb lining prevents implantation, and older women tend to have thinner womb linings anyway. 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 often combined with Clomid. IUI can remove any hidden problems where sperm and mucus are incompatible, 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

We suggest you maximise your chances of conceiving by following the personalised advice we provide for your “Fertility Profile”. There is also excellent information on this site explaining:

  • How to spot when you’re most likely to conceive.
  • The impact of lifestyle on fertility.
  • Tests to identify potential problems.
  • How stress is a significant player, and how to manage it.
  • Treatments for specific conditions and evidence herbs really help.

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 are specialist and difficult to access, but some of them are very accessible:

Tests for men 

Further testing for men involve 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.

Reference
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