Unexplained infertility

Overview

Unexplained infertility is when a couple has been trying to get pregnant for a year (or six months if the woman is over 35) and doctors cannot find a clear reason after doing standard tests. It does not mean there is no cause – just that the cause is not obvious.

Yes, unexplained infertility is one of the most common diagnoses given to couples who have trouble conceiving. It affects roughly 25% of infertile couples.

It affects people of all backgrounds who are trying to conceive. Both partners are usually healthy but for reasons that are not yet clear, pregnancy does not happen.

Symptoms

Common symptoms

• Not getting pregnant after a year (or six months if the woman is 35 or older) of regular, unprotected sex.

Causes

Main causes

• Subtle issues with egg quality or ovulation that standard tests miss.
• Mild sperm problems (like lower than average movement or shape) that do not show up on routine semen analysis.
• Very mild endometriosis or fallopian tube issues that are not detected by normal exams.
• Immune system factors or tiny genetic differences that affect fertilization or implantation.
• Lifestyle factors that may not have been fully explored, such as stress, weight, or smoking.

Risk factors

• Age of the woman (over 35 reduces egg quantity and quality).
• Being overweight or underweight.
• Smoking, heavy alcohol use, or using recreational drugs.
• High levels of stress for either partner.
• A history of pelvic infections.

When to see a doctor

See a doctor urgently if:

• If you have severe pelvic pain, especially with fever, bleeding, or if you think you might be pregnant.

Book a routine appointment if:

• If you have not become pregnant after one year of trying (or after six months if you are over 35).
• If you have irregular periods or known conditions (like PCOS or endometriosis) and are having trouble conceiving.
• If you have had a previous miscarriage or treatment for cancer.

Diagnosis

Your doctor will diagnose unexplained infertility after performing a set of standard tests on both partners and finding no clear reason for the difficulty getting pregnant.

Tests that may be done

• Semen analysis for the male partner – looks at sperm count, movement, and shape.
• Ovulation testing for the female partner – blood tests to check hormone levels around the time of ovulation.
• Hysterosalpingogram (an X-ray of the uterus and fallopian tubes) to see if the tubes are open and the uterus is normal.
• Pelvic ultrasound to look at the ovaries and uterus.
• Sometimes a laparoscopy (a small camera in the belly) to check for endometriosis or scar tissue.

What to expect at your appointment

The process usually takes a few months. You will be asked about your medical history, lifestyle, and how long you have been trying. Both partners will be involved. The tests are mostly done in the clinic or hospital as an outpatient. Your doctor will explain each step and what the results mean.

Treatment

Even though the cause is unknown, there are treatments that can help many couples conceive. The goal is to increase the chances of pregnancy by boosting fertility and removing any small barriers that may be present.

Self-care at home

• Have regular, timed intercourse around the time of ovulation (use an ovulation predictor kit or track your cycle).
• Maintain a healthy body weight – losing or gaining weight can improve fertility.
• Stop smoking, limit alcohol, and avoid recreational drugs.
• Reduce stress with relaxation techniques, counselling, or gentle exercise.
• Take a folic acid supplement daily if you are trying to conceive.

Medical treatments

Depending on your age and health, your doctor may suggest treatments such as ovulation induction (using medications to stimulate the ovaries to produce more eggs), intrauterine insemination (IUI – placing specially prepared sperm directly into the uterus around ovulation), or in vitro fertilization (IVF – fertilizing eggs with sperm in a lab and transferring an embryo into the uterus). These treatments are offered in fertility clinics and your doctor will explain the options, success rates, and risks.

When is surgery considered?

Surgery is rarely needed for unexplained infertility unless a problem like endometriosis or blocked tubes is found later. In most cases, treatment focuses on medications and assisted reproductive technologies.

Living with this condition

Living with unexplained infertility can be emotionally and physically challenging. It may feel like you are waiting and hoping without a clear path. Keeping a routine, staying connected with your partner, and taking breaks from trying can help.

Lifestyle tips

• Keep a healthy diet and exercise routine – but avoid overdoing intense exercise, which can affect ovulation.
• Get enough sleep and try to manage stress through hobbies, walks, or talking with friends.
• Limit caffeine to one or two cups a day.
• Avoid hot tubs or saunas for the male partner, as too much heat can affect sperm.

Diet and exercise

Eat a balanced diet rich in fruits, vegetables, whole grains, and healthy fats. Include foods with folate (leafy greens) and zinc (nuts, seeds). Moderate exercise like walking, swimming, or yoga is beneficial. Very high-intensity training may interfere with ovulation, so talk to your doctor.

Mental health and emotional wellbeing

Infertility can cause feelings of sadness, anxiety, guilt, and isolation. It can strain relationships and affect your self-esteem. It is normal to feel this way, and getting support is an important part of your care.

Prevention

Unexplained infertility cannot always be prevented because the cause is unknown. However, adopting a healthy lifestyle – such as maintaining a normal weight, not smoking, and managing stress – may reduce your risk of fertility problems.

Screening programmes

If you are planning a pregnancy, you can ask your doctor about fertility-related health checks, such as checking for sexually transmitted infections or assessing your menstrual cycle. But there is no specific screening test for unexplained infertility.

Complications

If left untreated

• Emotional distress and depression from ongoing difficulty getting pregnant.
• Strain on your relationship with your partner.
• Delayed conception, which can be harder as you get older.

Long-term outlook

The outlook for unexplained infertility is generally hopeful. Many couples eventually conceive, either without treatment or with help from fertility treatments. Even after a diagnosis of unexplained infertility, the chance of having a baby over time is good. Your doctor can give you a better idea based on your age and health.

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