Starting a family can be a difficult and emotional experience for many couples who suffer from infertility. While some cases of infertility have definitive causes, others may not be evident during normal fertility testing. These cases are grouped under unexplained infertility. Also called Idiopathic infertility, these are cases in which all tests are performed and no reason for infertility is established.

While reproductive research and medicine have progressed in leaps and bounds, the failure to conceive without reason remains a perplexing matter in fertility management as approximately 15% of all infertility cases can be attributed to this. However, ongoing research and clinical efforts continue to explore potential explanations and treatment modalities for unexplained infertility. There might be many reasons for unexplained infertility, here are some most common factors that may contribute for the same.

1. Ovulatory DysfunctionOne of the major causes of unexplained infertility is irregular ovulation or issues with the egg release. In normal conditions, there is only one egg released by an ovary and it gets fertilised by sperms. In cases of ovulatory dysfunction, a woman does not experience regular monthly ovulation. Regular ovulation occurs when there is a perfect balance between hormones, stress, and lifestyle. Healthcare providers may address this aspect of unexplained infertility by monitoring menstrual cycles and identifying potential abnormalities.
2. Egg QualityWomen are born with a fixed number of eggs and this amount keeps declining with age. The quality of eggs is the one of the determinants of a woman’s ability to conceive, and is defined by its potential to develop into an embryo once fertilised with a sperm. This phenomenon is, in turn, defined by the chromosomal make-up of eggs. Poor egg quality may be a result of maternal age, toxic environmental exposure, or an underlying medical disease – these lead to a decreased chance of conception even when other aspects of female fertility appear to be normal. People with poor egg quality find it hard to conceive while others, who conceive, are highly susceptible to miscarriages.
3. Poor Sperm QualityInfertility in men results from low sperm quality and/or quantity. This indicates that the sperm cells a man produces are not able to properly fertilise an egg. These problems can comprise of poor sperm count, low sperm motility, or abnormal semen morphology. They make it difficult for sperm to reach an egg and penetrate thus, making the fertilisation less likely. This explains why comprehensive fertility assessments should not be overlooked on the couple’s path to conception.
4. Undiagnosed Underlying ConditionsThere may often be undiagnosed underlying conditions, which may lead to unexplained infertility. Some of these conditions include mild endometriosis, where tissues similar to uterine lining grow outside the uterus interferes with implantation hence, causing infertility. Moreover, vaginal disorders that are not evident with regular fertility examinations, influence sperm performance and quality during fertilisation.
5. Fallopian Transport DefectsFallopian transport defects can be a major cause of unexplained fertility in a couple. Fallopian tubes are important for fertility as they carry eggs from ovaries to the uterus and serve as the location of fertilisation. Blockage or impairment of these tubes can disrupt the process of fertilisation and embryo formation, leading to infertility. In some cases, the fallopian tubes seem to be open. However, their function can be affected by severe damage to the inner lining, making it difficult to transport eggs and embryos. Many cases of unexplained infertility may result from minor tubal defects that are overlooked in standard fertility testing.
6. IsthmoceleIsthmocele, a common complication of caesarean sections, can cause unexplained infertility due to fluid accumulation in the uterus, leading to infection and damage to the embryo. This can result in multiple implantation failures, low ovarian reserve, and ultimately the need for IVF or donor oocytes. Repairing the scar through laparoscopy can restore fertility in patients who are unable to conceive otherwise.
7. Other FactorsSome other factors can include immunological factors which include immune system disorders and autoimmune diseases. This may affect the male and female reproductive systems and ultimately lead to infertility. Recent evidence shows that serum autoimmune antibodies are common among women with idiopathic infertility.Unexplained infertility can also be genetic involving both men and women. These genetic conditions affect the reproductive process and consequently cause problems in conceiving. Women may also experience ovulation disruptions and reproductive system malformations caused by genetic abnormalities, preventing conception. There are certain genetic disorders in men that can cause sperm abnormalities affecting fertility.

Unexplained infertility can be a complex and frustrating challenge for couples aspiring to build a family. By delving into various aspects of reproductive health, healthcare providers can uncover potential factors contributing to infertility. A collaborative approach, involving both partners in the diagnostic and treatment process, is crucial for a comprehensive understanding and successful resolution of unexplained infertility.