Defining the Unexplained Infertility Diagnosis

A couple that has been assigned the diagnosis Unexplained Infertility, obviously suffers from infertility and has undergone a diagnostic work up which failed to reveal a credible underlying cause for their condition. In other words, the diagnosis of UI is reached by default; it is a negative diagnosis, suggesting that a clinical problem exists but that the probable cause for this problem has remained elusive. Moreover, even if it were to exist, it would behoove us to improve the sensitivity of our diagnostic testing, so that testing procedures become able to detect even subtle and multifactorial abnormalities in the reproductive processes which can lead to infertility. The opposite is, of course, also true: the shoddier a diagnostic evaluation, the more often will it end up with a diagnosis of UI. The hypothetical conclusion that a couple suffers from UI will, therefore, greatly vary between practitioners, and what is considered UI in one practice may have a very specific diagnosis in another.

Unexplained infertility and female age

The likelihood of a diagnosis of unexplained infertility is increased substantially in women 35 and over - and greatly increased in women over 38. The reason for this is that there are more likely to be egg quantity and quality problems as women age. Since we do not have a "standard category" called egg factor infertility, these couples sometimes get lumped in to the "unexplained" infertility category. Most women over 40 who try to get pregnant will have difficulty, and fertility over age 44 is rare - even in women who are ovulating regularly every month. The point is that the older the female partner, the more likely that there is an egg related issue causing the fertility problem. Unfortunately, there is currently no specific test for "egg quality".

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