Frequently, couples that have been unable to conceive will undergo all the recommended diagnostic tests and still find nothing wrong. This is called unexplained infertility. Having unexplained infertility does not mean that there is nothing wrong, but rather that we are not clever enough today to determine what the problem is. It is not surprising that we cannot uncover the cause of infertility in many couples given that there are probably hundreds of processes that must work right for pregnancy to occur, and we only have valid tests for a handful of them.
If you have been diagnosed as having unexplained infertility, do not despair; it is among the most successfully treated of all diagnoses. However, our approach to treatment is a bit different than for other diagnoses. If, in the course of a diagnostic evaluation, we find a problem, we then design our treatment to correct that problem. However, for unexplained infertility, this is not possible: we don’t know what the problem is, so we cannot attack it directly.
The treatment for unexplained infertility centers around the fact that women with this diagnosis do get pregnant, albeit at a much slower rate than the general population. Our treatment approach is to try and speed up this rate. 2 approaches can be used: 1) creating more than 1 ovulation per month… this increases the number of targets and enhances the likelihood of a successful pregnancy occurring; and 2) placing more sperm in the vicinity of the eggs… this increases the chances that a sperm will fertilize an egg and produce an embryo.
Given these principles, there are 6 basic approaches used to treat unexplained infertility:
- This is the most cost effective approach to treatment. Pregnancies do occur with no treatment, but at a very low rate.
- Cost: $0/month
- Pregancy rate: 2% /month
- Clomid® (or Femara®)
- These oral drugs, when used in appropriate doses, will cause a woman who normally produces a single egg each month to produce 2 or 3. This will double or triple the pregnancy rate. However, each woman will respond differently to different doses of drugs; some will grow 3 eggs on a low dose, while others will grow no more than the usual 1 egg each month on higher doses of drugs. You will have an ultrasound performed during your treatment cycles so we can determine how many eggs you are growing each month. You may also be prescribed an injectable drug during the cycle to help your eggs ovulate or “drop”.
- Cost: $350/month
- Pregnancy rate: 5%/month
Clomid® (or Femara®) plus intrauterine insemination (IUI)
- Intrauterine insemination (IUI or artificial insemination) takes the best sperm produced and places it closer to the egg. Generally, most sperm do not make it from the vagina into the uterus and tubes, where fertilization happens. IUIs help to correct this, so that a majority of the sperm inseminated make it to the uterus and tubes. You can choose 1 or 2 inseminations in a month; 2 inseminations increase the success rate of pregnancy, but is also more expensive.
- One insemination per month
- Cost: $700/month
- Pregnancy rate: 8%/month
- Two inseminations per month
- Cost: $1050/month
- Pregnancy rate: 10%/month
Injectable fertility drugs plus intrauterine insemination
- These medications, commonly called gonadotropins, go by a variety of names such as Gonal-f®, Follistim®, Repronex®, and Bravelle®. They are very powerful drugs generally capable of producing a large number of eggs in a treatment cycle. With unexplained infertility, these drugs are used to produce more eggs than can be achieved with Clomid® or Femara®: generally 3-6 in a cycle. However, care must be taken to ensure that this is the goal that is met, and that too few or too many eggs are not produced. To do this, frequent monitoring with blood tests and ultrasound are required, as well as an occasional adjustment of the drug dose. These expenses, in addition to the expense of the drug, are significant, as is the time commitment and mental energy required. However, it is every effective in helping you achieve pregnancy. Two inseminations are usually used with this treatment.
- Cost: $3000/month
- Pregnancy rates: 15-22%/month
Femara and injectable fertility drugs plus intrauterine insemination
- This combination of oral and injectable drugs frequently is able to produce as many eggs as injectable drugs alone, but at a much reduced cost and far lower time commitment. The oral drug is given days 3-7 of your cycle, and the injectable drugs follow in varying doses.
- Cost: $1000-2000/month
- Pregnancy rates 10-20%
In vitro fertilization (IVF): Minimal Stimulation
- This treatment uses injectable fertility drugs and Clomid® in low doses, only a small amount of monitoring, and little or no dose adjustment. An egg retrieval is performed to remove up to 3 mature eggs from the ovaries. The eggs are then mixed with sperm in a Petri dish, and the following day all 3 fertilized eggs are transferred into your uterus. Please see the patient information sheet for minimal stimulation IVF for more details.
- Cost: $7000/month
- Pregnancy rate: 25%/month
In vitro fertilization (IVF)
- This treatment uses injectable fertility drugs to produce a large number of eggs. They are then retrieved from the ovaries, mixed with the sperm in a Petri dish and grown for 5 days in the laboratory. The best 2 embryos are then transferred into the uterus. Any embryos that are not transferred can be frozen for future family building if they are of good quality. Please see the patient information sheet for IVF for more details.
- Cost: $15,000/ month
- Pregnancy rate: 45%/month