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unexplained infertility...

What does this mean? Why can't there be a rhyme or reason for us to not be pregnant by now? Is there anything that I can do?

These are the questions that I'm faced with and the answers are all a little difficult to deal with. They are just as vague.

Here's a little bit of research:

Chance for getting pregnant on own - without fertility treatment - for couples with unexplained infertility
The duration of infertility is important. The longer the infertility, the less likely the couple is to conceive on their own. After 5 years of infertility, a couple with unexplained infertility has less than a 10% chance for success on their own.
One study showed that for couples with unexplained infertility and over 3 years of trying on their own, the cumulative pregnancy rate after 24 months of attempting conception without any treatment was 28%. This number was found to be reduced by 10% for each year that the female is over 31.

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Clomid and timed intercourse for unexplained infertility3-6 months of treatment with Clomid pills (clomiphene citrate) might improve fertility by as much as 2 times as compared to no treatment. This is a very low level infertility treatment. Infertility specialists do not usually recommend Clomid treatment( without insemination) for unexplained infertility for women over the age of about 35. Most fertility specialists do not use it (without IUI) on any couples with unexplained infertility. If a woman is already having regular periods and ovulating one egg every month, giving Clomid, which will probably stimulate the ovaries to release 2 or 3 eggs per month (instead of one) is not really fixing anything that is broken - and is not likely to be successful.

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Defining the Unexplained Infertility Diagnosis A couple that has been assigned the diagnosis Unexplained Infertility, obviously suffers from infertility and has undergone a diagnostic work up which failed to reveal a credible underlying cause for their condition. In other words, the diagnosis of UI is reached by default; it is a negative diagnosis, suggesting that a clinical problem exists but that the probable cause for this problem has remained elusive.

The reasons why underlying problems may not be recognized can, of course, vary. One possibility is that there, indeed, is no one obvious cause for a couple’s infertility and that their problem may be the result of multiple minor aberrations in how their respective reproductive systems cooperate. After all, the successful establishment of pregnancy is a highly complex process and, at least on a theoretical level, one can assume circumstances where male and female fertility, each, are affected only to such a mild degree that standard diagnostic tests would still be considered within normal parameters. Yet, together, the reduction in the couple’s combined fertility potential is large enough to cause infertility.

Whether such a circumstance, indeed, exists is, however, highly questionable. Moreover, even if it were to exist, it would behoove us to improve the sensitivity of our diagnostic testing, so that testing procedures become able to detect even subtle and multifactorial abnormalities in the reproductive processes which can lead to infertility. Any such improvement in diagnostic abilities would then, of course, eliminate the need for a diagnostic entity, called UI, which brings us to the main rational of our argument against the continuous usage of this terminology: Since the diagnosis of UI is a diagnosis of exclusion, it will be only as good (or bad) as the diagnostic work up that has been performed.

Another way of saying this is, that the more comprehensively and the more accurately the diagnostic work up is performed, the more likely will a cause for a couple’s infertility be detected and the less likely will they end up with a diagnosis of UI. The opposite is, of course, also true: the shoddier a diagnostic evaluation, the more often will it end up with a diagnosis of UI.

This, of course, creates a rather peculiar incentive structure: the poorer the medical care, the more likely a couple will end up with a diagnosis of UI; - exactly the opposite of what one would like to see with good medical practice where, of course, good care should be rewarded by better diagnostic accuracy, and not by less.

Physicians and their professional organizations disagree on what constitutes a complete infertility evaluation. The hypothetical conclusion that a couple suffers from UI will, therefore, greatly vary between practitioners, and what is considered UI in one practice may have a very specific diagnosis in another. Indeed, at CHR we have become convinced that four very specific conditions are frequently overlooked and, therefore, misdiagnosed as UI. We have reached this conclusion not only based on observations in or own patient population but also from a careful analysis of the medical literature.
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Does this help? Ugh, reading is for the birds...

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