Your tubes are clear, his semen count is okay and you have no history of STDs — everything is normal. But you can’t conceive normally. MAUREEN AKINYI explores, unexplained infertility, the most frustrating diagnosis
Picture this scenario: You and your spouse have been married for a year and have been trying for a baby since the honeymoon night … but no bump is forthcoming.
Perhaps it’s the stress and the pressures of daily life or simply anxiety — you console yourselves. The last thing on your mind is a fertility problem.
But after all these months of trying and disappointment, you decide to seek out more sophisticated medical advice — you book an appointment with a fertility expert.
After an array of tests for both of you, the doctor summons you to his office and gives you the piercing verdict: "All the tests are normal. You have unexplained infertility."
Ouch! You want answers. You’d rather be told your tubes are blocked, or hubby has a low sperm count, but not an intangible answer— unexplained infertility.
There is nothing as shattering and frustrating as being told you have a problem but the doctors cannot establish the cause.
PROBLEM WITHOUT A CAUSE
"Couples want to know why they’re not getting pregnant. Doctors are also trained to make a specific diagnosis. It’s incredibly stressful for everyone involved," says Nanette Santoro, MD, professor and director of reproductive endocrinology and infertility, Albert Einstein College of Medicine quoted in Conceive Online.
Agnes, who has been searching for a baby for three years, knows this too well: "I wanted answers but none was forthcoming. You are only told to be patient. It is a crushing verdict," she says.
So what exactly is unexplained infertility?
Medics define unexplained infertility as the inability to achieve pregnancy after one year of regular unprotected intercourse despite no apparent medical cause.
It’s a diagnosis of exclusion; to be made only after accepted fertility check-ups and testing have been completed on a woman and a man.
According to Dr Alfred Murage, a fertility expert at the Aga Khan University Hospital, a reproductive disorder is categorised as unexplained infertility when no definite cause of infertility has been found and basic investigations are all normal. These include normal semen, confirmed ovulation and normal fallopian tubes.
However, infertility is not that simplistic, and other factors may be at play even when such basic tests are normal.
According to fertility records in the country, unexplained infertility accounts for ten to 20 per cent of couples with infertility, but the exact figure is not known and also depends on other factors and how relevant studies are conducted.
Indeed, unexplained infertility is frustrating for doctors and patients. Dr Sandra Carson, professor/medical director, Baylor College of Medicine Assisted Reproductive Technology, concurs that it is "especially anguishing for patients."
"Not knowing is so fraught with anxiety. To be told ‘everything is normal’ is hard to accept when you’re trying to have a baby but nothing is happening," says Dr Carson.
DOCTOR SHOPPING
That’s especially true when a couple is already scheduling sex according to ovulation kits or aiming for the oft-recommended "three times a week or more" in order to get pregnant.
Dr Murage also agrees that subfertility is a distressing situation regardless of the actual cause.
"Couples will go through various emotions and each find different ways of coping. We routinely offer psychological support as part of sub-fertility treatment," he says.
The situation is so draining, most couples are prone to ‘doctor shopping’, with a good number of them turning to advertising in newspapers or on Internet websites to look for support.
Some unethical doctors also take advantage of the patient’s frustration and they claim to have successes that surpass others — or to be using ‘experimental’ fertility treatments that are "sure to become mainstream in the future".
But what causes this kind of infertility?
Some of these couples may have what is being dubbed ‘subfertility’ — a delay in getting pregnant that may be due to a relatively minor glitch somewhere along the line to producing a baby.
This is true based on tales, for example, of couples that adopted a child and then "miraculously," some years later, conceived.
Or of women who had stopped using birth control because they assumed they would never get pregnant only to find that they’re suddenly expecting.
That aside, Dr Murage says the main cause of subfertility in Kenya is blockage of the fallopian tubes, as determined by a recent study.
This commonly results from sexual infections or unsafe abortions.
TREATMENT OPTIONS
Condom use is a major preventive approach especially for those with multiple sexual partners. Prompt treatment of sexual infections may prevent advancement of disease to the fallopian tubes.
Other common causes are problems with ovulation and abnormalities with sperms.
Couples should be evaluated together, as the causes may be with either or combined.
So what are the treatment options for this verdict?
While doctors may not be able to find the cause of a couple’s infertility, they can offer advice — and even possible fertility treatments —to help or recommend the least invasive solution — time.
One major review of medical studies revealed that while 90 per cent of healthy, fertile couples conceive in the first year of regular unprotected sex, and another five per cent get pregnant in the second year, in the first three years of unexplained infertility, one in three couples will have a successful pregnancy with no treatment at all.
Dr Murage advises a young couple to wait longer and a good number will still conceive naturally.
Second, he also recommends ovulation medications combined either with timed intercourse or intra-uterine insemination of sperms.
"Some couples will not conceive with simple measures and may end up requiring more complex treatments like intra vitro fertility," Dr Murage explains.
The doctor says most young couples will conceive with simpler interventions, whereas some will need more complex interventions.
"Unfortunately, a small percentage of couples will not achieve success despite repeated treatments," he says.
Other prescriptions for women facing unexplained infertility that have not been scientifically proven to do anything but "enrich their prescribers", say experts, are immunoglobins, baby aspirin, antioxidant vitamins, and heparin.
For men, a good option is trial courses of antibiotics when no evidence of sexually transmitted disease or infection has been found.
