Can Someone Please Explain Unexplained Infertility?

Fertility issues are hard enough to deal with when you actually understand what's causing the problem. But if your infertility is unexplained—as is the case for 30% of infertile women or 50% of infertile men — not knowing what's keeping you from getting pregnant can get pretty damn frustrating.

For the sake of this post, we’ll be addressing unexplained infertility in females. Don’t worry, we talk allllll about the guys in other posts.

What the heck is unexplained infertility? 

Unexplained infertility means not only are you not getting pregnant, but also that the usual suspects don't seem to be behind your problem. According to Dr. Nataki Douglas, M.D., Ph.D., director of translational research for the Department of Obstetrics, Gynecology and Women's Health at Rutgers University in New Jersey, it's the diagnosis given to an individual or couple trying to conceive after a thorough evaluation already reveals normal ovulation, a normal uterus and patent fallopian tubes, and a normal semen analysis.  

That means you've probably already done a huge battery of tests (egg assessment, an ultrasound and hysterosalpingogram (HSG), and semen analysis), and basically only up with a big shrug of the shoulders. So that leads to hunting elsewhere for a problem, and dealing with a lot of uncertainty in the meantime. We know. Not fun.  

So, what's happening?

Unexplained infertility doesn't exactly mean that there's no explanation at all. You may have undergone all the routine tests, but there is likely some explanation for your infertility hiding somewhere. Here are some of the additional factors that could be at play:

Diet

Consider this the perfect reason to clean up your diet, if you haven't already. Recent research from the Harvard T.H. Chan School of Public Health and Harvard Medical School has shown that diet plays a role in conception.

For women, that means boosting your intake of folic acid, vitamin B12, and omega-3 fatty acids, along with following a generally healthy diet, while men need to follow a healthy diet and reduce their intake of trans fats and saturated fats. Bottom line: If you think your diet could be a factor, it may be worth seeing a nutritionist to see if you can find a fertility-enhancing diet that works for you.

Autoimmune issues

If you've been diagnosed with an autoimmune disease like lupus, your medical team has likely already weighed in on how your condition and your treatment could impact your fertility. But even milder autoimmune issues could be a factor in your fertility, according to the Oncofertility Consortium, either by attacking your ovaries, uterus and other tissues, or by interfering in the ability of a fertilized egg to implant.

However, the jury is still out on what role autoimmune issues may play in unexplained fertility—and some doctors aren't convinced. "Autoimmune testing is controversial amongst different leading reproductive endocrinologists today in the field," says Dr. Janelle Luk, medical director and founder of Generation Next Fertility in New York City. "But I say try anything and everything within your means to get pregnant."

Weight

Several studies have shown that being overweight or underweight can impact your chances of getting pregnant. A 2015 study found that obesity, for instance, can increase levels of chemicals called adipokines, which causes insulin resistance and impacts your fertility. There's also a link between being overweight and developing polycystic ovarian syndrome (PCOS), which can wreak havoc on your menstrual cycle and reduce your chances of conceiving.

On the other end of the spectrum, being underweight (a body mass index of 18.5 or lower) could cause your body to stop producing estrogen, which could keep you from ovulating.

Egg quality

The initial fertility workup may only look at whether eggs are present and ovulation happens, but unfortunately, won't be able to address egg quality. You may need to move into more aggressive fertility treatments like IVF to get a picture of whether your eggs are viable.

While [IVF] will cost you some change, it could be the most proactive way of figuring out what's going on.

Dr. Luk advises her patients with unexplained infertility to not make IVF the last resort. While it'll cost you some change, it could be the most proactive way of figuring out what's going on—and could uncover some egg quality answers.  

Stress

You've probably heard "just relax and it'll happen" so many times, you fantasize about punching the next person who suggests it (hey, just being honest). But there is some science to back up the idea that the impact of stress on your body could be a factor in your fertility. And yes, we totally get the irony that the stress of not getting pregnant could be keeping you from getting pregnant.

While research is conflicted about the effects of stress itself, some studies indicate that stress can impact your sleep patterns, your mental health, and other factors that may play a part in your fertility.  

If you're feeling stressed, a little me time can't hurt. Dr. Francis suggests investing in some yoga, meditation, or acupuncture to help you feel more zen.  

How to avoid freaking out

In many ways, unexplained infertility feels a lot worse than dealing with an actual diagnosis. The Type-A planners in us like answers and explanations. "Our psyche just does better knowing 'why,'" says Dr. Marra Francis, MD, FACOG, an OB/GYN in The Woodlands, Texas.

If you're going through infertility, you might feel like a train stuck between stations. Definitely not a good feeling. Communication is key to getting through this; you're not a mind reader and neither is your partner. "Check in with each other," says Crystal Clancy, MA LMFT, PMH-C, owner of Iris Reproductive Mental Health. "Don't assume that you know what the other is thinking and feeling."  

As you're working through your feelings—you've got a lot of 'em—and your action plan, it may pay to get a little professional help, too. Don't hesitate to seek out a mental health professional who understands infertility to help guide you. A strong support system is always a good thing.