Infertility is a medical problem affecting the reproductive system that is defined the a difficulty of conceiving, even with regular unprotected sexual intercourse after 12 months or more. Infertility evaluation is usually initiated after one year of trying conceiving, but in couples with advanced female age (above 35 years), diagnostic evaluation can be initiated after an inability to conceive for six months.

Sometimes, despite all the standard infertility evaluation tests are normal, but the couple is still unable to conceive. This is when a diagnosis of unexplained infertility is conformed. Standard infertility evaluation and tests include-semen analysis, assessment of ovulation, and a hysterosalpingogram (tubal patency), and, if indicated, tests for ovarian reserve and laparoscopy. Unexplained infertility is also commonly known as idiopathic infertility.

In approximately 10% of couples trying to conceive, all of the above tests are normal and there is no easily identifiable cause for infertility.

Assessment of Male Infertility: Sperm Analysis

For an infertile couple an assessment may include evaluation of male partner by his history, physical examination, and semen analysis. A physical examination would help identify and detect testicular abnormalities such as a varicocele or absence of the vas deferens.

Semen analysis is sometimes called also sperm count. It measures the amount of semen a man produces, determine the number and quality of sperm in the semen sample as well as the motility and the shape of the sperms.Semen is the thick, white fluid released during ejaculation that contains sperm.

Assessment for Female Infertility:

Assessment of Ovulation

In a women with a regular cycle, ovulation is expected to take place 14 days before the next period bleeding starts. So in women with a 28 day cycle, ovulation will take place on day 14, and in a woman with a 30 day cycle on day 16. Abnormal menstrual cycle suggests the presence of ovulatory dysfunction, therefore ultrasonographic and laboratory assessment of ovulation should be done.

During the first phase of the cycle the growth of the follicle can be monitored by the ultrasound, measuringthe size and checking on the appearance of the follicle. Additional laboratory assessment can be done by monitoring the rise of the level of Estradiol, the hormone that is produced by the growing follicle.

The occurrence of ovulation is easily documented by mid luteal phase serum progesterone level, which may be obtained approximately one week before the expected menses. For a typical 28 day cycle, the test would be obtained on day 21.

Assessment of Ovarian Reserve

The term “ovarian reserve” refers to a woman's current supply of eggs and is closely associated with the chance of pregnancy. The greater number of remaining eggs, generally means the higher the chance of possible conception. On the contrary, low ovarian reserve significantly reduces a patient's chances for conception. Besides the number of eggs, the quality of the eggs is very important and the quality is mainly linked to the age of the woman.

Assessment of Uterus and Fallopian Tubes

Assessment of the uterine shape and the tubal patency is an important part of the basic infertility evaluation. Hysterosalphingography (HSG) is used widely for uterus and tubal evaluation and is fairly accurate in detecting tubal disease.

HSG provides a delineation of the fallopian tubes, allowing of tubal patency, tubal occlusion, and tubal irregularity. To exclude any underlying cause, it is also recommended to perform a genetic testing to exclude any genetic cause of infertility, prior speaking of “unexplained infertility"

The Role of Laparoscopy in Unexplained Infertility Evaluation

Laparoscopy allows direct visual assessment of the pelvic reproductive organs; it is the assessment to identify an otherwise unrecognised peritoneal factor that influence fertility like endometriosis. A laparoscopy is recommended for those women with unexplained infertility who show signs and symptoms of endometriosis or there is suspicion of reversible adhesive tubal disease. (American Society for Reproductive Medicine Guideline).

Treatment-options for unexplained infertility

Lifestyle Changes

There are studies indicating that cigarette smoking, abnormal body mass index (BMI), excessive caffeine and alcohol consumption may reduce fertility.Hence, the couple should be encouraged to achieve a normal BMI, reduce caffeine and alcohol intake and perform the moderate physical activity.

Intrauterine Insemination (IUI)

It is a type of artificial insemination which involves the placement of sperm (that have been washed and concentrated) directly into the uterus after the follicle growth had been monitored and ovulation was triggered, for the ovary to release one egg to be fertilised.

In Vitro fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI)

In vitro refers to outside the body and fertilization refers to the sperm that attached to and entered the egg. In vitro fertilization (IVF) is the union of egg and sperm in a laboratory dish. The developing embryo is then transferred into the woman's uterus.

In the ICSI technique, a single sperm is injected directly into an egg to fertilize it. Normally this isthe technique to overcome infertility due to impaired semen quality. But it can also be used in patients with unexplained infertility when IVF-techniques leads to low fertilisation rates (low number of fertilised eggs even with normal egg and sperm quality).

IVF with ICSI is an accepted method of treatment for unexplained infertility. It is expensive and invasive, but it is considered to be the most effective method. IVF has the advantage of a proven record of success, resulting in an increased pregnancy rate in patients with unexplained infertility.

The IVI Middle East Fertility Clinic is committed to helping patients with all types of fertility issues in conceiving. From more holistic approaches including diet and lifestyle modification to advanced treatments like in vitro fertilization (IVF) and ICSI, our staff can enthusiastically guide you towards pregnancy. Take the first step, please contact us, we are happy to speak with you.

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