Dr Richa Sharma
In continuity with our series of articles, here are we with another one for the awareness of couples suffering from these issues.
Infertility itself is a very stressful condition and the worst part of the scenario is when our battery of investigations cannot single out the causative factor- so often labeling as Cause cant be detected /Idiopathic !! Its adds to the stress further not only of the couple and the family but also creates dilemma for the treating doctor-as which recommendation is optimal when everything seems apparently normal. As patient, many questions arise and disturbs as to Why me ?? This single WHY carries a whole lot of vicious circle if not interrupted on time with scientific help based on evidence based medicine.
Definition
Patients where the results of a standard infertility evaluation are normal or whose problems do not “explain” their infertility are assigned a diagnosis of unexplained infertility
When such diagnosis is made ?
Diagnosis of unexplained infertility is made if the basic infertility evaluation fails to reveal an obvious cause for failure to conceive.
The basic evaluation should provide evidence of adequate sperm production, ovulation and fallopian tube patency. If indicated, tests for ovarian reserve and laparoscopy should also be done.
At present, even the most sophisticated diagnostic assessment cannot reveal all of the possible abnormalities.
Therefore unexplained infertility appears to represent either the lower extreme of the normal distribution of fertility, or it arises from a defect in fecundity which cannot be detected by the routine infertility evaluation.
If this group of patients are followed up without treatment 30 – 50 % will ultimately achieve pregnancy. The success will depend on the age of the couple, the duration of their infertility and how extensive their evaluation was before being classified as “unexplained Infertility”.
Incidence
15% to 30% of couples will be diagnosed with unexplained infertility after their diagnostic workup.
Possible Reasons-Defects which result in implantation failures are probably much more common than we realize and constitute another area of unexplained infertility. Assaying implantation factors like integrins may lower the incidence of unexplained infertility in our patients.
Prevalence will depend on-
* Stratagies followed
* Referral pattern
* And how the various tests are interpreted
Affects on fertility-
Couples with unexplained infertility suffer from both diminished and delayed fecundity, compared with the normal fertile couples.
Treatment modalities-
It’s a diagnosis of EXCLUSION !!
In the absence of a correctable abnormality, the therapy for unexplained infertility is, by default, empiric.
Proposed treatment regimens include intrauterine insemination (IUI), superovulation with oral or injectable medications, combinations of IUI with superovulation, and the assisted reproductive technologies
(ARTs).
When considering treatment options for couples with unexplained infertility, it is prudent to consider simple treatment before complex treatment and to balance what is known about effectiveness against the cost and adverse effects of different treatments.
Selection of treatment option depends on
* Duration of infertility
* Woman’s age
* How extensive was the evaluation?
* Estimated chance of success
* Cost involved
* Risk & side effects of each method
* Couples own preference
Conclusions-
In summary, evaluation of disease characteristics can help clinicians to select the most appropriate active therapeutic option, thus allowing basic tailoring of treatment modality to the individual.
(The author is Senior IVF Consultant Gurgaon)
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