Unexplained infertility: Causes, treatments, and how to move forward

An illustration of an upset couple struggling with an unexplained infertility.
  • Updated Dec 17, 2024
  • Published

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Created with Natasha Lowe Osho, MD, Obstetrician-Gynecologist, USA

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In a nutshell

Unexplained infertility is a condition in which a person or couple can’t achieve pregnancy despite normal medical test results. It occurs for no visible reason but can affect 15% to 30% of couples. 

Typically, it can be caused by any hormonal or reproductive issue that is too subtle to be shown by medical evaluation. Luckily, this condition most likely doesn’t mean you won’t ever be able to get pregnant—many couples can conceive with the help of such solutions as:

  • Lifestyle changes: Switching to a balanced diet, quitting smoking, reducing caffeine intake, limiting alcohol intake, and implementing regular exercising.
  • Unexplained infertility treatment: Ovulation induction, intrauterine insemination (IUI), and in vitro fertilization (IVF).
  • Solid emotional support.

Why am I not getting pregnant? For some women, this question might be especially frustrating if all their medical results are normal, but they still haven’t been able to conceive. This phenomenon is called “unexplained infertility,” and it might be more common than you’d think.

In this article, we will tell you about the common causes of unexplained infertility, associated challenges, and ways to move forward.

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What is unexplained infertility?

Unexplained infertility is a term used by healthcare providers to explain the infertility of a person or couple that occurred despite the fact that medical tests didn’t reveal any obvious causes.

This condition is only diagnosed if a couple under 35 years old has been trying to conceive for at least a year—or at least six months, for those 35 years and older. Moreover, the diagnosis is given only if both partners have undergone thorough evaluations, and tests didn’t reveal any of the following infertility causes:

  • Uterus structural issues
  • Uterine abnormalities
  • Irregular ovulation
  • Fallopian tubes obstructions
  • Low ovarian reserve
  • Hormonal imbalances that might hinder reproduction
  • Semen analysis issues (e.g. with count, motility, amount, etc.)
  • Other underlying conditions that might affect fertility, such as PCOS, HPV, and others

Though it may sound surprising, this condition isn’t too rare. A study by Obstetrics & Gynecology claims that approximately 15% to 30% of couples are diagnosed with unexplained infertility after a complete medical evaluation.

Possible causes of unexplained infertility

Since this condition is diagnosed when medical evaluation doesn’t detect any abnormalities or issues in you or your partner, the specific reasons for unexplained infertility remain unclear. Still, the underlying causes that affect male or female infertility are typically the same:

  • Hormonal imbalances
  • Poor egg or sperm quality
  • Issues with egg-sperm interaction during fertilization
  • Uterine or tubal issues
  • External and lifestyle factors, such as excessive stress, poor diet, environmental toxins, etc.

So, what’s the difference between regular and unexplained infertility if the causes are so similar? The primary distinctive feature is that with unexplained fertility, these conditions might present so subtly that standard tests and screenings fail to reveal them. 

👉Find out more: Why am I not getting pregnant? Understanding common reasons for conception challenges

Why am I not getting pregnant when everything is normal?

The traditional medical evaluation for couples that are trying to conceive often consists of the following stages:

  • Ovulation tests. A healthcare provider might take a blood test to measure the level of LH hormones and determine if your ovulation phase is regular and when it takes place. Additionally, doctors can use a combination of blood tests (FSH, Estradiol, and Anti-müllerian Hormone (AMH)) and vaginal ultrasound to evaluate your ovarian reserve.
  • Semen analysis. Apart from checking the female’s ovarian reserve and ovulation regularity, sperm analysis is also an important part of infertility diagnosis. A healthcare provider will likely take sperm samples to analyze morphology and other possible infertility issues.
  • Imaging tests. These tests leverage fluoroscopy to take pictures of the uterus and fallopian tubes. The goal of imaging testing is to ensure that there are no uterus abnormalities or fallopian tube obstructions that might cause fertility issues.
  • Hormone testing. Lastly, it’s important to note that hormone levels play a pivotal role in reproductive health. Hence, hormonal blood testing might also be included in the overall fertility evaluation. Performed at the right time by a healthcare provider, hormone testing can reveal imbalances that might be hindering your chances of conception or, on the contrary, be a sign of fertility if hormones are well balanced.

These basic elements of a fertility medical evaluation are typically conducted for couples that have been trying to conceive for some time but didn’t get pregnant. The problem is that, in the case of unexplained infertility, the results of all these tests should be normal, leaving unexplained infertility causes unclear.

How to get pregnant with unexplained infertility

Although the reasons for unexplained infertility remain unclear, which can complicate treatment, having this diagnosis does not mean that you can’t get pregnant. There are three basic tips that can help you get pregnant with this condition prior to receiving any specific treatment:

Tracking ovulation to optimize timing

Ovulation tracking is one of the first things you can do to boost your chances of conception. By understanding when you ovulate, you can more precisely adjust the timing of attempted conception to fit it into your fertile window.

There are a few ways to keep an eye on your ovulation. First, you can try tracking the physical signs of high fertility, such as clear and slippery mucus that resembles raw egg white, increased basal body temperature, and others. You can also track your ovulation using a calendar if your cycle is regular enough. This can be easily done with modern-day tools, such as the Femia app, which easily pinpoint your days for conception. Yet, of course, the most effective and accurate way to track your ovulation is with the help of ovulation kits.

Maintaining a healthy lifestyle

Lifestyle habits, such as diet, smoking, caffeine alcohol consumption, and exercise, tend to have a significant impact on female hormones and fertility. Thus, changing your lifestyle is one of the natural ways to boost female fertility.

To increase your likelihood of getting pregnant, consider following a more balanced fertility diet and incorporating regular physical activity. Such changes should help you balance your hormones and maintain a healthy weight, which can improve your fertility. There are certain fertility exercises you can incorporate into your routine to stay active and help with weight management to improve your chances of conception. 

Also, try integrating stress management techniques like breathing, meditation, and mindfulness to reduce daily stress, which is known to affect the pituitary gland and disrupt the production of important reproductive hormones responsible for egg release (ovulation).

Considering alternative approaches

Apart from adjusting the timing of sex and improving your lifestyle, there are also a few unexpected ways to boost the chances of pregnancy. One of them is acupuncture. A study of acupuncture and herbal medicine treatment for unexplained infertility has yielded a successful pregnancy rate of 60.9%. Acupuncture has been shown to help increase the blood flow to the ovaries and uterus, helping to regulate menstrual cycles. It is often linked to reduced stress levels, which also aids fertility.

In addition to acupuncture, consuming the right fertility supplements might also help in addressing unexplained infertility. However, keep in mind that both of these alternative treatment methods can do both good and harm, which is why it’s important to consult a doctor before trying them.

Unexplained infertility treatment options

If ovulation tracking and lifestyle adjustments don’t bring the desired results, several unexplained infertility treatment options can be applied:

  • Ovulation induction. This treatment uses medications like Clomid or Letrozole to stimulate ovulation, increase the number of eggs released during every cycle, and help improve overall ovulation patterns, making it more predictable for a greater chance at conception. These medications also change the balance of fertility hormones in your body, which can also have a positive effect.
  • IUI. This medical procedure involves placing specially prepared sperm directly in the uterus to make it easier for the sperm and egg to unite and cause pregnancy. 
  • IVF. This treatment method includes extracting a mature egg, fertilizing it in a lab environment, and transferring embryos to the uterus for further development. It is a common and effective treatment option. However, given that this treatment is invasive, it’s typically considered later in the process if other options don’t work.

👉Find out more: How long should you be off birth control before trying for a baby

Emotional challenges of unexplained infertility

Trying to conceive for a long time and not being able to achieve pregnancy can be incredibly frustrating, especially when your medical evaluations went well. This can lead to ongoing stress and a feeling of hopelessness when you don’t understand the reason for not getting pregnant when everything is normal.

These emotional challenges can have an additional impact on your chances of conception. A study by the National Institutes of Health and the University of Oxford revealed that cortisol and adrenaline produced during prolonged periods of stress can reduce fertility by 12%. Hence, it’s important to address the emotional side of unexplained infertility. For example, consider:

  • Joining support groups,
  • Seeking counseling,
  • Maintaining open communication with your partner,
  • Integrating mindfulness, self-care, and stress-coping practices.

When to consult a fertility specialist

Every woman’s journey to pregnancy is different. Often, natural conception doesn’t happen too quickly. For most couples, it’s normal to get pregnant within a year of regular sex with no contraception, so it’s important to stay patient and follow your path.

Still, there are several baseline recommendations to keep in mind about when to seek specialized care:

  • If you’ve been trying to conceive for a year with no success (or after 6 months if you are 35 years or older).
  • If you notice cycle irregularity or are concerned about other fertility issues, and natural hormone-balancing strategies don’t seem to bring tangible results.
  • If you want to explore advanced fertility treatments.
You can't get pregnant any time of the month

Femia offers the most accurate tool for determining fertile days

Try Femia now

Questions from the Femia community

  • Does unexplained infertility mean I’ll never get pregnant?

    No, it doesn’t. Although this condition can make it harder to conceive, the National Institute of Health (NIH) has revealed that 92% of couples with unexplained infertility ultimately had a child after receiving proper care and treatment. That is, there are chances to conceive both naturally and with the help of treatment.

  • Is IVF the only option for unexplained infertility?

    No. There are quite many things you can do to boost the likelihood of conception with unexplained infertility. The options range from rather simple ones, like lifestyle adjustments, to medical treatments like IUI or ovulation induction. Typically, these treatments are tried before IVF.

  • Should I get a second opinion for unexplained infertility?

    Yes, if you were diagnosed with unexplained infertility but are not positive about this condition or the treatment plan you are offered, it can be helpful to see another specialist for clarity.

  • Can unexplained infertility resolve on its own?

    Yes, it’s possible. Sometimes, persons with this diagnosis can conceive naturally with time or by trying ovulation tracking and lifestyle adjustments. However, seeking treatment can improve your chances and reduce the time you’ll need to get pregnant.

  • Does unexplained infertility affect men and women equally?

    Yes, unexplained infertility can affect both men and women. It can be caused by very subtle issues in either partner’s fertility—for example, poor sperm quality, egg quality, etc.

The bottom line

“My tests are normal, so why am I not getting pregnant?” This might be one of the most frustrating concerns facing people on their conception journey. Yet, the truth is that this phenomenon affects as many as 15% to 30% of couples.

Unexplained infertility might be confusing, but it’s not rare. It takes place when there are no evident reasons for infertility. Luckily, it doesn’t mean that you can’t get pregnant.

As you now know, there are many management tips and treatment options that can help improve your chances of conception. So, if you’re trying to get pregnant, be patient, but stay proactive, and don’t hesitate to seek emotional support or fertility assistance when necessary.

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