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Unexplained Infertility

By Dr. Joe Massey, MD

What is Unexplained Infertility?

Unexplained infertility can be a very frustrating diagnosis to hear from your doctor. A diagnosis is considered “unexplained infertility” when a couple has been trying to conceive without success for six months (woman is over 35) or one year (younger than 35) and has been through thorough testing with no identifiable culprit. This testing includes, at a minimum, a semen analysis, evaluation of the uterus with ultrasound, and imaging studies for tubal status. Unexplained infertility is truly a diagnosis based on elimination. While science has come a long way in the history of infertility, we still do not have the tools to identify every cause.

You are considered to have unexplained infertility if you have not conceived, but the following are true:

  • Normal semen analysis
  • Regular periods/ovulation
  • Normal ovarian reserve
  • Healthy fallopian tubes with no blockages
  • Healthy uterine environment, without significant fibroids

How often does unexplained infertility occur?

It is common. Approximately 15-30%1 of infertile couples are considered to have unexplained infertility. Fortunately, there are treatments that can be successful even with this uncertain diagnosis.

“After all of those tests, you still don’t know why we aren’t conceiving?”

What do we do now that this is the diagnosis?

In the past, unexplained infertility was believed to account for approximately 10% of infertility cases—but that was in the days when laparoscopy was almost always done in patients who had no apparent explanation.

Since laparoscopy is not performed often for unexplained infertility in today’s practice, especially in the older age group of women, many couples have no further diagnosis. We can assume that many of the women have endometriosis, but your physician most likely will not recommend stopping the plan of action to treat the endometriosis. Moving on without a clear diagnosis to ovulation induction and IUI or IVF are the common options to consider.

Women under the age of 35 who’ve had a reasonably short period of infertility can elect to have laparoscopy to investigate further. This is even more highly recommended if there is significant pain with periods, because if this surgical procedure reveals endometriosis, it can be ablated, enhancing fertility.

Sometimes, persistence with Mother Nature can be the answer. An argument for this approach is that if one is willing to try timed intercourse for three to six months before jumping to IVF, then laparoscopy may be appropriate for you. An advantage of this approach is that laparoscopy is commonly covered by insurance.

For women in their early 30s and younger with unexplained infertility, intrauterine insemination (IUI) is frequently the first approach. Washed and concentrated sperm is placed in the uterus during ovulation. Generally, IUI is recommended for several cycles before moving to the next step. If IUI is unsuccessful and for older women, IVF is usually that next step.

Going through IVF can actually reveal the underlying reason for infertility, such as low-quality eggs that could not be tested through other means. Regardless of whether more is revealed about the causes of your infertility, IVF dramatically improves the odds of conceiving in most situations.

Is there hope?

Infertility is usually a relative term. With unexplained infertility, you don’t have an absolute barrier to conceiving. While it can be an extremely frustrating diagnosis, there is hope. Many people conceive spontaneously through timed intercourse within one year of the diagnosis. IUI and IVF are also very successful options in this category of infertility. Once the diagnosis of unexplained infertility is made, it’s a good idea to talk to your medical team and make a plan of action that includes all the options.




As a well-known pioneer in IVF, Dr. Joe Massey loves to share in the joy of helping build families. Dr. Massey’s achievements in fertility medicine include involvement in the first pregnancy in the world following assisted hatching in 1988 and in the world’s first pregnancy following intracytoplasmic sperm injection (ICSI) in 1993. He has led a number of clinical trials and co-authored many articles published in medical journals.

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