Unsuccessful pregnancy without a specific reason is stressful and unpleasant for most infertile couples, as well as their gynecologists. Candidates for unexplained infertility treatment are found in almost 15-30% of infertile patients who may not be able to become pregnant due to undetected causes after major fertility investigations. Candidate causes for unexplained infertility treatment are: a) oviduct dysfunction with tubal patency, incl. gametes and embryo transport disorder, as well as oocyte retrieval failure at the tube fimbria, b) fertilization failure, and c) implantation failure without organic lesion.
ART, including IVF, may overcome tubal dysfunction and fertilization failure, but cannot overcome recurrent implantation failure (RIF). As to the RIF, hysteroscopy as well as blood tests for an immunological abnormality, and recurrent miscarriage should be performed as a clinically practical implantation test.
Unexplained infertility treatment, as well the treatment of RIF, is a means of eliminating detected causes. If there is no reason for implantation failure, the unexplained infertility treatment strategy includes endometrial injury during the luteal phase, systemic single-dose injection of G-CSF at embryo transfer, transfer of a vitrified-warmed single blastocyst with assisted hatching, and hyaluronan-enriched transfer medium.
Unexplained Infertility Treatment Strategy
In any case, the undetectable causes of infertility inhibit the processes of sperm and egg encounter or implantation after fertilization. Thus, candidates for unexplained infertility treatment cannot use the general infertility treatment, including timed sexual intercourse or intrauterine insemination (IUI). The cumulative pregnancy rate for general infertility treatment is 10-20% in unexplained infertility patients, which is comparable to survival.
Evidence of unexplained infertility treatment:
Percentage of unexplained infertility treatment in infertile couples: 15-30%,
Cumulative pregnancy rate with general non-ART or expectant treatment: 10-20% (clinical pregnancy rate: < 5% per month),
Cumulative pregnancy rate according to the general fertility method with superovulation using gonadotropins: 50-60% (clinical pregnancy rate: 20% per month)
Cumulative pregnancy rate after laparoscopic surgery: 20-30% (clinical pregnancy rate: 6% per month).
When enrolled in IVF, the causes of unexplained infertility treatment are often revealed.
Therefore, timed intercourse or IUI should not be repeated discursively. IVF or intracytoplasmic sperm injection (ICSI) can overcome tubal dysfunction and fertilization failure. In candidates for unexplained infertility treatment, gynecologists should explain the reasons of why patients cannot conceive and discuss active infertility treatment, like ART.