Looking for Answers?

Dealing with a diagnosis of unexplained infertility can be tough but what is ‘unexplained’ infertility and what does it mean for your chance of conception?

Unexplained infertility is defined as the lack of an obvious cause of infertility and failure to achieve a pregnancy after 12 months of unprotected sex, or 6 months in women over the age of 35. In part the diagnosis of unexplained infertility is attributable to the extent and quality of clinical diagnostic tests. The European Society of Human Reproduction and Embryology guidelines state that necessary tests should include semen analysis, assessment of ovulation and the luteal phase, and assessment of fallopian tube anatomy (checking your tubes are not closed) by hysterosalpingogram (a procedure using contrast dye and x-ray to view the anatomy of your tubes) or laparoscopy.

Can I Conceive with Unexplained Infertility?

Spontaneous conception rates in unexplained infertility are actually likely to be higher than couples with a defined cause of infertility. In a review of studies on unexplained infertility it is reassuring that 50% of couples diagnosed with unexplained infertility would conceive spontaneously in the subsequent 12 months, and 12% in the next year [1, 2].

What are Some of the ‘Causes’ of Unexplained Infertility?

In studies that have investigated couples with a diagnosis of ‘unexplained infertility’, some of the primary causes have been attributed to poor egg and sperm quality.

Sperm DNA fragmentation. This is a major factor in unexplained infertility [3]. There are now recommendations to incorporate testing for sperm DNA fragmentation into routine clinical practice. Sperm is quite susceptible to inflammation and oxidative stress which can damage sperm, causing DNA fragmentation [4]. Inflammation and oxidative stress can be related to diet and not getting the right balance of physical activity and rest.  Male factors, such as increased oxidative stress, are also implicated in recurrent pregnancy loss [5]. Assisted reproductive treatments cannot improve DNA fragmentation but there is clear evidence for the effectiveness of reducing DNA damage with the right nutrition and exercise prescription.
 
Elevated Oxidative stress and Inflammation. One study has reported that in females with unexplained infertility, over 70% had high levels of inflammation and oxidative stress [6]. These elevations in inflammation and oxidative stress impact upon oocyte (egg) quality and the endometrium. Altered expression of key proteins in the endometrium are found in infertile women compared to women that have had successful pregnancies suggesting that receptivity of the uterus plays a role in unexplained infertility [7]. Women with polycystic ovary syndrome (PCOS) also have altered expression of receptor proteins in the uterus but lifestyle modifications (through diet and exercise) have been effective at improving receptor levels  [8].

Improving Your Chance of Success

While IVF and other assisted reproductive treatments will not improve the quality of your eggs and sperm, YOU CAN! You want to give your embryologist the best ingredients possible to work with. Evidence supports that the right exercise prescription and nutrition guidance can improve your chance of success. Want to know where to start? Join us for expert advice and guidance.

References
1. Gelbaya TA, Potdar N, Jeve YB and Nardo LG. Definition and epidemiology of unexplained infertility. Obstet Gynecol Surv. 2014;69: 109-115.
2. Sadeghi MR. Unexplained infertility, the controversial matter in management of infertile couples. J Reprod Infertil. 2015;16: 1-2.
3. Esteves SC, Agarwal A, Cho CL and Majzoub A. A Strengths-Weaknesses-Opportunities-Threats (SWOT) analysis on the clinical utility of sperm DNA fragmentation testing in specific male infertility scenarios. Transl Androl Urol. 2017;6: S734-S760.
4. Tartibian B and Maleki BH. Correlation between seminal oxidative stress biomarkers and antioxidants with sperm DNA damage in elite athletes and recreationally active men. Clin J Sport Med. 2012;22: 132-139.
5. Mohanty G, Swain N, Goswami C, Kar S and Samanta L. Histone retention, protein carbonylation, and lipid peroxidation in spermatozoa: Possible role in recurrent pregnancy loss. Syst Biol Reprod Med. 2016;62: 201-212.
6. Maxia N, Uccella S, Ersettigh G, Fantuzzi M, Manganini M, Scozzesi A, et al. Can unexplained infertility be evaluated by a new immunological four biomarkers panel? A pilot study. Minerva Ginecol. 2017.
7. Elnaggar A, Farag AH, Gaber ME, Hafeez MA, Ali MS and Atef AM. AlphaVBeta3 Integrin expression within uterine endometrium in unexplained infertility: a prospective cohort study. BMC Womens Health. 2017;17: 90.
8. Paulson M, Sahlin L and Hirschberg AL. Progesterone Receptors and Proliferation of the Endometrium in Obese Women With Polycystic Ovary Syndrome-A Lifestyle Intervention Study. J Clin Endocrinol Metab. 2017;102: 1244-1253.