Nafeeza (name changed),30 year old lady and her husband Imran, 32 years of age have been trying for a baby for the past three years.They have been informed by their Specialistthat all the tests performed for both her and her husband are normal. The couple wondered why in spite of all tests being normal, they still are not able to conceive.
This couple have unexplained infertility.
What is unexplained infertility?
A systematic and standard evaluation of all couples with infertility involves three initial tests viz. Confirmation whether ovulation (egg release) takes place.
Assessment of tubal patency by either an x-ray test called hysterosalpingogram or by laparoscopy Semen analysis
If the results of all these three basic tests are normal and the couple have been trying for a pregnancy for at least one year, the diagnosis of unexplained infertility is made.
How common is it?
One in three couples who are not able to conceive has unexplained infertility.
What are the causes of unexplained infertility?
The term unexplained infertility could be a misnomer as in fact often this could be because there is something wrong at a more basic level. It is possible that this could be due to subtle defects in the process of ovulation (egg growth and release) or in the process of fertilisation (when the egg and sperm meet to form embryo or due to poor egg, sperm or embryo quality). The third reason is that it could be due to defects in implantation (the process of embryo attaching to the womb lining and growth).
What are the treatment options of unexplained infertility?
There are only two treatment options available for unexplained infertility viz, IUI or IVF.
Until recently, empiric treatment with ovulation induction drugs were used to treat this cause, however, recent research has categorically shown that this treatment is not beneficial.
What is IUI?
Intra Uterine Insemination (IUI) involves placing of prepared sperm of the husband high into the cavity of the womb and this insemination procedure is carefully timed to coincide with the time of ovulation (egg release). Additional medication (Oral/injectables) are also used to increase the number of eggs produced doing a treatment cycle.
What is IVF?
IVF stands for In Vitro Fertilisation, commonly known as test tube baby treatment. The basic principle involves removing a number of mature eggs from the ovary, fertilising them in the laboratory using sperm and then transferring up to 3 (usually 2) fertilised eggs (embryos) back into the womb for implantation and further growth.
What is the chance of success of these treatment modalities?
In general, with one cycle of IUI the pregnancy rate is around 15%. Upto 6 cycles of IUI could be tried before moving to IVF though most of the pregnancies resulting from IUI occur within the first 3-4 cycles of IUI treatment. With IVF, each cycle gives a take home baby rate of around 30-35%.
DR.S.VYJAYANTHI, MD, DGO, DNB, MRCOG (London), MSc (Embryology) (UK)
Head of Department and Consultant in Infertility, Reproductive Medicine and Surgery
Krishna Institute of Medical Sciences