Unexplained infertility when the cause of infertility is not found is a subject in which agreement is rarely found between specialists. Unexplained infertility refers to a diagnosis or a lack of diagnosis mainly in couples in which all the standard investigations such as tests for ovulation, tubal patency and semen analysis are normal. Unexplained infertility is a term that may be applied to close to 30% of infertile couples and it is possible that the potential causes may be described as disturbances in the endocrine system, the anatomy , genetic or the reproductive cycle.
In our review published in 2012 in Reproductive Biomedicine on line, we extensively reviewed all the practices and the treatments of unexplained infertility. The use of Clomiphene in unexplained infertility, although cheap and easily available, did not show any advantage for using this drug.
NICE in 2004 had recommended IUI as a treatment option for unexplained infertility and although it is cheaper than IVF, recently evidence has questioned the role of Intrauterine insemination over six months. IVF has the advantage of approved record of success in unexplained infertility. Since IVF addresses the interaction between the sperm and the egg in the laboratory it allows us a better view into the causes of unexplained infertility.
What is the best treatment to obtain the best results for unexplained infertility? There is no definite answer and the options are of either trying two to three cycles of stimulated IUI or proceeding with IVF. It is important to identify more subtle causes of infertility, which can be achieved by extensive investigations into the causes of infertility.