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Treatments and Further Tests

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on January 20, 2017
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Unexplained Infertility: Treatments and Further Tests

Couples have been trying to conceive for a year or more before further testing, and treatments for unexplained infertility are usually considered, based on the woman having: i

  • A normal structure to her womb.
  • Healthy “patent” Fallopian tubes.
  • Regular ovulation.

And the man has:

  • Enough healthy-looking sperm.

There are generally two responses to an “unexplained” diagnosis:

  1. Continue trying in the knowledge there aren’t any apparent blocks to pregnancy.
  2. Seek medical intervention to increase the chances of conceiving.

Standard treatments

When couple’s choose to have medical intervention, what tends to happen is a standard rather than a personalised approach:

  1. The woman goes on a course of clomiphene citrate (Clomid) for three to six menstrual cycles to induce ovulation (even if problems ovulating have been ruled out). Clomid isn’t always recommended for women over 35 as it reduces the thickness of the womb lining. A thin womb lining prevents implantation, and older women tend to have thinner womb linings anyway, so it can worsen an existing issue. Clomid is generally most successful for younger women with a normal or higher BMI.
  2. IUI (intrauterine insemination) is usually the second treatment option, often combined with Clomid each cycle. IUI has the advantage of removing any hidden problems where sperm and mucus are incompatible, something that’s an issue for about 20% of infertility cases.
  3. The third option is to have several (usually 3) IVF cycle treatments. ii

Herbal medicine

Research suggests that combining IVF or IUI with herbal medicine significantly increases success rates, and a herbal/ IUI combination had a 65.5% conception rate, compared with 39.4% in the IUI group. iv Herbal medicine has a different diagnostic framework that can recognise patterns and provide personal treatment options. It’s effectiveness at improving general health and raising sexual function, is supported by research that shows it increases: v

  • How many follicles reach the last stage of development.
  • The size of Dominant Follicles.
  • The thickness of the womb lining after ovulation.
  • Blood flow in the corpus luteum.
  • Progesterone levels in the luteal phase.
  • Blood flow in the uterine artery.
  • Pregnancy rates.

It also reduces:

  • FSH levels at the start of cycles.
  • Immune function irregularities.

Additional Tests

When the standard tests can’t find anything that prevents pregnancy, tests that go “above and beyond” the standard tests become more appropriate. Some of these are specialist and difficult to access, but some of them are very accessible:  [show_to accesslevel= “premium” no_access=’

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Tests for men

Further testing for men do involve specialised sperm analysis to see if they can fertilise an egg and maintain a viable pregnancy:

Tests for women

Women should have had all the standard tests for infertility, but the availability varies. In an ideal world, women with unexplained infertility have:

  1. Blood tests for sex hormones and to check the status of her ovarian reserve.
  2. Laparoscopy to look for endometriosis, even when there aren’t any symptoms of endometriosis. Endometriosis has a significant impact on fertility, but laparoscopy is not always part of fertility testing.
  3. Altered immune status checks as immune disorders are a hidden cause of infertility. Women need to provide blood or tissue samples. and men need to give a semen sample. There’s more information about this in immune issues.
  4. Thyroid testing (that includes T3 levels) is something all women should have, and both clinical and subclinical hypothyroidism is thought to affect fertility. Using saliva samples for this is possible, and supplementing may be enough to regain thyroid function.
  5. Abnormal structures in the womb can be missed up to ¼ of the time when part of the initial fertility “work-up”. 25% is a large percentage and makes having a hysteroscopy to re-check the uterus a good idea. vi
  6. Thrombophilia is a significant player in miscarriage and infertility, so it’s essential women have a blood test to exclude this factor.
  7. Bacterial vaginosis is present in a surprisingly high percentage of women and contributes to unexplained infertility. Simple tests and treatment options are available, and the microbiome of the vagina and gut are closely connected. A healthy diet and taking probiotics encourages microbiome health throughout the body.
  8. Make sure your diet is balanced and contains enough folate for a baby to develop normally.
  9. Avoid toxins and lifestyle choices that increase oxidative stress and reduce the chances of a healthy pregnancy.
  10. Follow the more personalised advice for your “Fertility Profile”.
  11. Consider treatments such as herbs or acupuncture that will improve your chances of conceiving.

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i ‘Future evaluation and treatment of unexplained infertility’ Michael P. Diamond, June 2016. Volume 105, FertStert. Issue 6, Pages 1457–1458
ii “A randomised clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial”. Reindollar, R. H. et al. (2010) Fertility and Sterility 94 (3): 888
iii http://www.thehorse.com/ViewArticle.aspx?ID=19730
iv http://www.eurekalert.org/pub_releases/2012-01/afot-emw010912.php
v ‘Measuring the effectiveness of Chinese herbal medicine in improving female fertility.’ Trevor Wing and Elke Sedmeier. Journal of Chinese Medicine. 80. Feb. 2006. 22-28
vi Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. Reprod Biomed Online May 2004;8(5):590-94