Friday, February 6, 2009

Unexplained Infertility...what is it??

This entry is coming to you to give you information on unexplained infertility. Although a lot of people suffering with infertility have a specific diagnosis, there are many who have no known reason for their infertility.

Typical story: You and your partner have tried for at least a year to get pregnant with no luck. You’ve both gone for fertility testing and are just waiting to hear the results so that you can get started on some type of treatment. No matter what the diagnosis is, you know that you and your partner can work through it. You’ve both prepared yourselves for the worst. But have you prepared yourself to hear "After reviewing your tests, there doesn’t seem to be any reason for your infertility?"

"What? There is no cause for my inability to conceive? After all those tests you still can't give me any answers?!"

Approximately one in five couples will experience unexplained infertility despite completing a full infertility work-up. The emotional response can be difficult, maddening and frustrating. Couples who do find out a specific cause find their situations difficult, too, of course, but knowing the "whys" may make it more bearable. In cases of unexplained infertility, couples feel that one reason, one cause is lurking in a shadowy corner. It just hasn't been uncovered yet.

This is what you need to remember: You are doing everything you can, you are seeing the best doctor and you are becoming an educated consumer. Before you feel like all hope is lost, try to see the situation in a different light. Perhaps the issue isn’t that your fertility is some big enigma. Rather, try to remember that scientific knowledge is limited and testing devices aren’t always adequate enough to provide a proper diagnosis. Therefore, the actual reason for your infertility may not be known yet or no tools exist that are able to properly diagnose your infertility.

It is extremely difficult for those with unexplained infertility to know when to stop looking for a cause, to say "enough is enough." You may feel stuck unable to get on with other options because you hang on to those slender threads of hope that the cause of your infertility will be revealed in the next test or treatment.

In reality, there are probably hundreds of "causes" of infertility. What this means is that there are a lot of things that have to happen perfectly in order to conceive and have a baby. As a simplified example:

  • The hormones that stimulate egg development must be made in the brain and pituitary and be released properly
  • The egg must be of sufficient quality and be chromosomally normal
  • The egg must develop to maturity
  • The brain must release a sufficient surge of the LH hormone to stimulate final maturation of the egg
  • The follicle (eggs develop in structures called follicles in the ovaries) must rupture and release the follicular fluid and the egg
  • The tube must "pick up" the egg
  • The sperm must survive their brief visit in the vagina, enter the cervical mucous, swim to the fallopian tube and "find" the egg
  • The sperm must be able to get through the cumulus cells around the egg and bind the shell (zona pellucida) of the egg
  • The sperm must undergo a biochemical reaction and release their DNA package (23 chromosomes) into the egg
  • The fertilized egg must be able to divide
  • The early embryo must continue to divide and develop normally
  • After 3 days, the tube should have transported the embryo into the uterus
  • The embryo must continue to develop into a blastocyst
  • The blastocyst must hatch from its shell
  • The endometrial lining of the uterus must be properly developed and receptive
  • The hatched blastocyst must attach to the endometrial lining and "implant"
  • Many more miracles in early embryonic and fetal development must then follow...
A weak link anywhere in this chain can cause failure to conceive

The above list is very oversimplified, but the point is made. There are literally hundreds of molecular and biochemical events that have to function properly in order to have a pregnancy develop. The standard tests for infertility barely scratch the surface and are really only looking for very obvious factors, such as blocked tubes, abnormal sperm counts, ovulation regularity, etc. These tests do not address the molecular issues at all. That is still for the future...

Getting Pregnant
The duration of infertility is important. The longer the infertility, the less likely the couple is to conceive on their own. Even though your infertility problems may not be rationalized by modern science, it does not mean that you must lead a childless life. Studies have shown that a couple’s chance of naturally conceiving after three years of unexplained infertility range from 1% to 6% per month compared to a fertile couple, who have a 20% chance of conceiving in any given month. Although these may not be the best odds, it shows that it is possible to spontaneously conceive without the aid of any fertility drugs.

Some couples, though, prefer to increase their odds of conceiving by utilizing various fertility treatments. Using infertility drugs, like clomiphene or injectable fertility drugs to aid in ovulation for several cycles, many couples have found success with intrauterine insemination and in vitro fertilitzation. In fact, some studies have shown that couples with unexplained infertility have a better success rate with these techniques than couples with explained fertility problems.



1 comment:

Tonya said...

Great post Amber. I learned a lot! Waiting to hear some good news for you two.