Dr. Gunasheela Gynaecologist & Obstetrician, Chairperson Of The Indian Branch Of Royal College Of Obstetricians And Gynaecologists Of U.K.

Approximately one out of every five cases of infertility is caused by unexplained factors. Unexplained infertility refers to the condition where there is no obvious cause for a couple’s infertility. Infertility is said to be 'unexplained', if the woman is ovulating regularly, has patent fallopian tubes with no evidence of endometriosis. Also, the husband should have a normal seminal sample and is capable of depositing the same in the vaginal ward resulting in a good post coital result in the woman’s ovulatory cervical mucus. The couple must have been trying to conceive for at least one year with frequent intercourse, particularly around the time of ovulation. But as one delves deeper into the various aspects of the physiology of reproduction, one may finally stumble upon the correct answer.

But obviously, couples will be more interested in achieving pregnancy than finding out the intricacies of gamete biology. However, it is much easier for them to know where the problem lies, knowing “this is what went wrong” than hearing “we don’t know what is wrong”. Finding out that one is infertile is a difficult situation by itself, but not knowing the cause makes it even more unbearable. The emotional reaction to hearing such a response can be very frustrating. They should realise that, unexplained infertility is a phenomenon that most couples find hard to reconcile with.

What are the possible causes of unexplained infertility?

• Tubal Abnormalities – Tubes may be mobile and patent. From the radiological appearance, they maybe normal. But one may find that the tubal fimbria maybe tethered with fine additions due to some old pelvic inflammation. There may be a slight defect in the mechanism by which the fimbria "pick up" the egg at ovulation or the cilia in the tube may not function correctly. The celia might have been destroyed by some form of mild infection.

• Abnormal Eggs – These are small, tiny microscopic forms, which are available for inspection if you aspirate a fluid filled swelling called follicle in the ovary. The presence of the follicle is suggestive of having an ovum inside. One will not know whether the particular follicle does contain an ovum, unless the follicular fluid is sucked out. Also, the ovum may be healthy, mature or immature, degenerate. So a good percentage of eggs inside the follicle are not fertilizable. Sometimes the fertilizing defects maybe in the spermatozoa itself.

• Implantation Problems – After the follicle has ruptured, liberating the ovum, the cells of the follicle fold inwards and form a structure known as the corpus luteum. Any abnormality in this phase is known as a luteal phase defect. At this stage, the body undergoes a change. The cells inside the follicle start producing a new hormone called progesterone, which takes care of the uterine lining – the endometrium, for implantation. It is important to monitor the quantity of progesterone produced in the 2nd half of the menstrual cycle.

• Inability Of Sperm To Penetrate Eggs – There is evidence to suggest that the sperm, though adequate in every other way, is unable to fertilize the egg. The only way to make this diagnosis is through IVF. If the donor’s sperm can fertilize the egg, but the husband’s sperm fails to do so, then the diagnosis is confirmed.

• Immunological Reactions – In some cases, the immune system can react against the man’s sperm and kill them or immobilize them. Women can also develop an immune reaction to the coating of their own eggs, which can prevent the sperm from penetrating them.

However, one must say that inspite of all the above factors, patients must look for a first rate laboratory where procedures are done on a regular basis. Though it is difficult to accept from a psychological point of view, treatment for unexplained infertility is often straightforward and the success rates are high.

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