Unexplained Infertility

In our patients who have difficulty conceiving, if no problem is found despite standard infertility tests, we consider it as unexplained infertility. In other words, we can define it as having difficulty in having a baby even though everything is normal.

This group constitutes an average of 20-25% of the couples who have difficulty in having children. No problem can be detected in gynecological examination and ultrasonography, and the sperm result of the male partner is found to be normal. However, when we perform laparoscopy on our patients in the unexplained infertility category, endometriosis and pelvic adhesions are detected in a group of our patients, and these patients are now transferred from the unexplained infertility category to the known infertility class. Therefore, the actual unexplained infertility rate is around 10-20%.

In fact, it is a general term that no reason can be found. Of course there is a reason, but it is sometimes very difficult to determine it. Because pregnancy is a process in which many factors and stages must be successfully passed, and it is a very complex chain of events. I would like to give some examples:

How does pregnancy occur, which stages must be passed perfectly;

• Hormones are secreted from the brain from the centers we call hypothalamus and pituitary and give orders for egg development in the ovaries. .(GnRH,FSH,LH)

• The developing egg must be of good quality and carry perfect genetic material

• This perfect egg It must be able to grow and mature well by the ovaries, under the command of hormones coming from the brain, and turn into a mature egg from the stage we call preantral follicle, and go through at least 4-5 stages and become ready for the final maturation.

• The brain must be ready for the final maturation. It must secrete a sufficient amount of LH hormone at the right time to reach the final maturity of the egg and pull the trigger for final maturation. This trigger should neither be pulled too early nor too late...

• The small ovulation cyst, which we call a follicle and which contains the matured egg, must rupture and be able to throw the mature egg it contains towards the tubes, towards the tube opening called fimbria. .

• The tube and fimb responsible for welcoming the matured and laid egg The organ we call ria must do its job of catching the egg.

• Meanwhile, with sexual intercourse performed at the right time, the sperm released into the vagina manages to stay alive, swim through the gel-like mucus layer in the cervix, and enter the uterus and then into the tubes. It has to go and find the egg that is taken into the tube and carried towards the uterus.

• When it reaches the egg, it passes through the cumulus cells that surround the mature egg like a snowball and attaches to the egg's protective shield called zona pellucida. The sperm that has the acrosome organelle must be able to make this connection successfully.

• The sperm that manages to bond must be able to penetrate the shield we call zona by secreting its biochemical enzymes and put its genetic nucleus, which carries 23 chromosomes, into the egg.

• The genetic nuclei of the prospective mother and father must combine 23 chromosomes each to form a healthy embryo with 46 chromosomes and sex chromosomes and begin to divide. It should transition to a 2-cell state in the 24th hour.

• The embryo, which begins to divide and multiply, should continue and the number of cells we call blastomeres should increase rapidly and turn into a 64-cell state. It must complete this transformation perfectly.

• In the 72nd hour of fertilization, the tubes must carry the embryo towards the uterus. The embryo must have reached the mother's uterus on the 6th day and must be prepared for attachment.

• The embryo must continue to develop and expand, turning into the form we call blastocyst.

• >The blastocyst must melt its protective shield and begin to cling to the mother's uterus.

• The uterine membrane must complete its final preparation and wrap itself around the embryo trying to cling, just like a quilt, and support its clinging, and must be of sufficient thickness.

• Attachment to the mother's uterus must be completed successfully and pregnancy must begin. Pregnancy will begin and detectable pregnancy hormone production will occur in the blood. The pregnancy journey has now begun for the expectant mother.

The perfect and miraculous embryo journey and pregnancy formation are briefly like this. Thousands of biochemical and molecular events occur in this process. It is extremely complex and involves many stages. It is a passing process. If there is a problem in these stages, pregnancy cannot occur, and while the person is having trouble getting pregnant, we doctors generalize this situation as unexplained infertility because it is difficult to explain these stages and why the problem cannot be detected at the microscopic level with tests or is difficult to detect. Current infertility tests actually offer a superficial and general evaluation.

So:
•    Sperm count
•    Uterine film
•    Gynecological ultrasonography and examination 
•    Hormone analysis Of course, superficial tests such as
cannot reveal whether the above complex sequence of events is working properly. Of course, there is a reason for not being able to get pregnant, but it is difficult to determine and impossible for some reasons.

Unexplained infertility and female age:

The underlying reason lies in age-related deteriorations in egg quality and number. A woman's age is one of the most important factors in getting pregnant. For this reason, the rate of unexplained infertility increases in our patients who are older and have baby problems, and our patients have difficulty getting pregnant even though they want a baby after their 40s and no reason can be detected and their hormones are normal. In addition, there is no test that shows egg quality.

Unexplained infertility and mild endometriosis:

The probability of mild endometriosis among women is around 25-30% and there is no test to show that it does not cause infertility. . The nature of endometriosis is to attack all female organs and fertility and pregnancy are affected by this. For this reason, these patients are considered in the category of unexplained infertility instead of mild endometriosis.

What are the chances of couples with unexplained infertility problems getting pregnant spontaneously without any infertility treatment?

Treatment Options for unexplained infertility problems:

Although it depends on the age of the expectant mother and father and the duration of infertility, in general:
1.    Ovulation treatment with pills
2. &nbs p; IUI
3.    In vitro fertilization or microinjection

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