The diagnosis of unexplained infertility is made after all standard evaluation tests in the infertility investigation are normal. Its frequency varies between 10-30% in infertile patient groups, depending on the diagnostic criteria.
The diagnosis of unexplained infertility is made by normal semen analysis, objective evidence of ovulation, normal uterine cavity (inside the womb) and bilateral tubal cavities. It is placed when there is clarity. Although it was said in the past that a positive postcoital test and an endometrial biopsy result compatible with the menstrual cycle were required, these tests are no longer used today.
The necessity of diagnostic laparoscopy in women with unexplained infertility is controversial. Laparoscopy can diagnose undetected tubal factor and endometriosis disease and provide treatment or limit unnecessary treatments for unexplained infertility. However, in women with normal HSG (Hysterosalphingography-Uterine and canal film) and pelvic examination but no risk factors for tubal factors, laparoscopy will not provide additional clarifying information. While the effect of endometriomas (chocolate cysts) involving the ovaries and advanced endometriosis disease on infertility is certain, the effect of intermediate disease has not been proven. Many physicians state that vaginal ultrasonography performed during the menstrual period or in the early post-menstrual period would be more appropriate instead of diagnostic laparoscopy in the evaluation of infertility.
Unexplained infertility, sperm or oocyte (egg) dysfunctions that cannot be diagnosed by standard evaluation methods, fertilization (fertilization) fertilization), implantation (adhesion into the uterus) or embryo development disorders. The pregnancy rate per cycle in untreated patients is 2-4%, or 80-90% below normal fertile couples (20-25%). Pregnancy possibilities independent of treatment are inversely proportional to increasing female age and duration of infertility. Although most infertile couples with unexplained reasons can become pregnant without treatment, decreasing pregnancy rates over the years require them to apply for treatment. The aim of the treatment is to increase the monthly pregnancy rates to the level of normal fertile couples.
TREATMENT APPROACHES
As can be understood from the definition, the cause of unexplained infertility is unknown. For this reason, treatment approaches are made according to previous experiences and the aim is to increase the number of sperm and eggs meeting at a certain time.
The development of one or more eggs can be achieved with drugs in pill form such as clomiphene citrate and letrozole. Pregnancy has been tried to be achieved through scheduled intercourse, and the superiority of the methods over each other has not been demonstrated.
Observations in in vitro fertilization treatment cycles will help us to have information about the causes of unexplained infertility in couples. During the procedure, sperm and oocyte will be brought together and fertilization will be achieved by microinjection method. In in vitro fertilization cycles, fertilization and early embryonic development will be monitored and placed into the uterus (endometrial cavity) by direct embryo transfer. Factors related to the chromosomal structure of the implanted embryo, the response of the inner layer of the uterus (endometrium) and the mechanism of implantation (attachment to the uterus) are not fully known.
When evaluated together, the effectiveness of treatments for unexplained infertility is limited and the treatment can only facilitate pregnancy that may occur at the specified time. . The evaluation should be made carefully and the couples should be evaluated with ovarian reserve tests, taking into account their age, duration of infertility and previous pregnancies before treatment planning. Couples who accept treatment should be informed about the pregnancy possibilities and risks of different treatment methods and the procedure, so that they can choose the one that is most suitable for them.
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