October 20, 2005 • ISSUE 52 / VOLUME 1

Unexplained infertility still a mystery

Early evaluation proves critical to positive outcomes

Dr. Kenneth Vu advocates early and appropriate evaluation to help achieve successful outcomes relating to infertility.	It is estimated that a young couple may have up to a 20 percent chance of conception per month for the first three to six months of trying.

By Kenneth Vu, M.D.
Medical Director
Hawaii Center for Reproductive Medicine and Surgery

About 17 percent of couples with infertility of at least one year duration are diagnosed with "unexplained infertility." It is a diagnosis of exclusion, meaning the diagnosis is made after a standard evaluation of the infertile couple has failed to provide a clear explanation for the cause of their infertility.

What is included in a standard evaluation may be controversial and debatable. However, most experts in the field of reproductive medicine agree that the evaluation for the female partner should include a history, examination, assessment of ovulation, associated hormonal evaluation, hysterosalpingofram (radiological imaging study of the reproductive tract to assess tubal patency and intrauterine cavity environment) and often laparoscopy (a surgical examination of the pelvic reproductive organs by placing a small scope into the abdomen).

For males, the evaluation should include a history, examination by urologist and a semen analysis. Infertility cause is unexplained because there are limits to medical science and a limited amount of professionals to evaluate human fertility and identify definitive causes.

Assuming all findings are normal, there is a critical element of timing for conception to occur. It is estimated that a young couple may have up to a 20 percent chance of conception per month for the first three to six months of trying. This chance decreases to less than 10 percent if no conception has occurred by one year and to 1-2 percent in couples with unexplained infertility of greater than three years duration. There are effective treatments such as intrauterine insemination with fertility-inducing medicine and in vitro fertilization to achieve higher rates of pregnancy in the "unexplained infertility" couples.

Age is an important factor as a cause of "unexplained infertility." One-third of women deferring pregnancy until their mid to late 30s experience difficulty conceiving. The effect of age on fertility is commonly assessed by a cycle day 3 FSH and estradiol level.

Early and appropriate evaluation of infertility can lead to empirical and advanced reproductive treatments, which may result in successful outcomes.

For more information, contact The Hawaii Center for Reproductive Medicine and Surgery, 941-3322, 261-4166 or e-mail drkvu@yahoo.com.