Unexplained Infertility - a lazy diagnosis?

Unexplained infertility.  It’s one of the most frustrating diagnoses, because it is basically saying – we don’t know what the f*ck is wrong with you.

Wikipedia defines it as – infertility that is idiopathic in the sense that its cause remains unknown even after an infertility work-up, usually including semen analysis in the man and assessment of ovulation and fallopian tubes in the woman.

A part of me resents the fact that this definition exists.  I feel like it gives our specialists permission to provide you a diagnosis without actually providing you with an answer.  It feels like a full stop. Now, I know that this isn’t always the case, and I don’t want to insult or put ALL fertility specialists under this category.  But I think it can lead to laziness. 

I know what it feels like to be on the receiving end of that unknown. 12 months into our fertility journey, we decided to go down the path of IVF, because we’d been unsuccessful so far in getting pregnant naturally. I remember sitting across from our fertility specialist after she told us that my uterine lining wasn’t thick enough, and they couldn’t transfer any of our embryos until we worked it out.  She said she’d go and ask a few other doctors their thoughts.  And in our next appointment, she sat across from us, and when we asked her what we could try next, she shrugged her shoulders.  We walked out of that appointment feeling completely lost and alone.  We were left to our own devices.

Unexplained infertility is basically saying – we have no idea.  And while some specialists will work with you and continue to run tests and provide options, others will shrug their shoulders and direct their attention at the next patient who won’t make their success rate statistics plummet.

Some will fight for you, and others will tell you that it’s a matter of numbers.  And if we just keep doing the same thing, chances are it will work.  Unfortunately, some of us don’t have the luxury of time or money……..and don’t get me started on the emotional capacity that this takes.

This is similar to the unspoken rule about miscarriages.  We won’t investigate until you’ve had 3 losses, which shows us that there is a problem.  And even then, it can still be unexplained, which means that you are basically rolling the dice with your heart and your life.

And then what happens is, it places the obligation on YOU and I.  Mere mortals with zero medical background, and just a Google search engine, to figure it out. So, we google the shit out of our symptoms, we try different potions, we change our whole lives and turn them upside down searching for the cause of our infertility.  Now I'm all for advocating for ourselves, but that’s not our job.  We’re not supposed to be the ones to investigate, are we?  

But I feel like an unexplained infertility diagnosis then pushes it back onto us.  Our doctors have provided us with an answer, without actually providing us with any clue on how to proceed (some of them, anyway).  They are basically shrugging their shoulders, just like my first fertility specialist. 

The leading cause of unexplained infertility? Poor egg quality, poor semen quality, reduced embryo quality or poor embryo development, and improper embryo and womb interactions during implantation.

I feel like the “poor egg quality” diagnosis is thrown around a lot too. Even before doing IVF, it can be the default diagnosis.

Which has a huge impact on us.  We internalize.  As women, we take on the blame and responsibility (even if it isn’t our “fault”). We feel guilty and helpless and spiral.  We are without direction.  And then we punish ourselves.  We should have started trying to conceive sooner.  We shouldn’t have smoked all those cigarettes, taken recreational drugs, or drank too many shots of sambuca in college. It all comes back to haunt us. It leads to resentment of those who get pregnant easily, despite living unhealthy lifestyles.

And then it becomes a little deeper.  Maybe this is a sign I’m not meant to be a mother?  Maybe it’s because I’d make a terrible mother?

All because of an unexplained infertility diagnosis.  The impact is wide-reaching and can be devastating.

So, what can you do if you get this response from your doctor?

Firstly, if it comes with a shrug and a full stop – get the heck out of there and find another doctor.  One who won’t use this as an excuse and push it on you to find a solution.  Some of my clients have the most amazing fertility specialists who do extensive research, who change protocols and speculate about what could be the cause and provide a solution.  And this is so powerful.  It gives you some comfort that this next cycle may be different, and that you’re not just crossing your fingers blindly or rolling the dice yet again.

It also gives you trust in your specialist, because it means that they are doing their job, and reduces the pressure on you.  And when you are paying them a shit tonne of money, that’s what you are entitled to.  You are entitled to an answer, even if it’s an educated guess.

I received a message from someone recently saying that she was diagnosed with unexplained infertility and was told that IUI and IVF were the only solutions.  After 6 failed IUI’s and 3 failed transfers, she pushed harder and harder and finally had an exam that revealed she had inflammation in the uterus, which was most likely preventing implantation.  Once this was solved, she was able to get pregnant naturally.  This haphazard diagnosis caused her to waste time, money, and energy.

This is so upsetting because IVF is becoming the solution that is thrown around too freely.  Just do IVF, right?!  This was the solution given to us, and we ended up getting pregnant 5 years later naturally at the age of 39!

Of course, this is a two-way street also.  We are also responsible for doing what we can. It could be that your body is trying to tell you something.  Lean into your intuition. If you have a sneaking suspicion that you have endometriosis or PCOS or a food intolerance, advocate for yourself.  Trust that you know more about your body than your doctors. 

There are also things that both you and your partner can do here as well.  Refer to my previous blogs on increasing egg and sperm quality HERE and HERE. 

At the end of the day, however, the responsibility of explaining unexplained infertility needs to rest on the shoulders of our medical specialists.  They are the ones who have the qualifications.  They are the ones you are paying.  And anything less……well…….I’ll let you be the judge of that.