What Does The Term Unexplained Infertility Mean? Here Is The Information To Help You Find Real Answers

What Does The Term Unexplained Infertility Mean? Here Is The Information To Help You Find Real Answers

If you have been trying for a baby for a while, unexplained infertility are the two most frustrating words to hear from your doctor. You feel like you are not seen or heard, just another way of saying “we have no idea why it isn’t working, so just keep trying and it will probably work in the end.” 

Hearing this doesn’t reassure you, it just causes more pressure and stress, two of the other factors that don’t help someone who is having fertility issues. 

At CRGH, we look say to our patients that the term “unexplained” usually just means “unexplored.” 

One in six couples in the UK face fertility issues. Dr. Wael Saab, our fertility specialist and senior medical director, is a specialist in complex cases and firmly believes that with the right diagnostic path, most couples can find the “why” behind their struggle and, more importantly, see a way forward. 

Here are five areas you need to investigate if you are tired of waiting for the answers: 

1. The AMH Test 

If you didn’t already know, women are born with all the eggs they will ever have. Many people don’t realise is how much the egg reserve can vary from person to person, regardless of age. 

An AMH (Anti-Mullerian Hormone) test is a simple blood test that reflects the amount of eggs you have left in  your ovarian reserve. 

• Higher levels generally mean a larger number of eggs. 

• Lower levels suggest the reserve is diminishing, which is more common particularly over the age of 40. 

AMH tests only tell half the story – they give us the insight about the quantity of eggs, not the quality. You could have a high AMH but still struggle if the eggs themselves aren’t viable. That is why this test is just one piece of the puzzle. 

2. A fertility assessment

If your doctor requested a basic blood test, then you don’t have the full picture about your fertility. A specialist fertility assessment goes much deeper. 

This involves conducting an internal ultrasound scan between days one and five of your cycle. This is when we look for “antral follicles”, the tiny fluid-filled sacs that have the potential to release an egg. When we combine this follicle count with blood tests for FSH and Oestradiol, we get a much more accurate picture of how your ovaries are actually functioning. 

3. Don’t ignore the male factor 

In heterosexual couples, we must talk about the man, as they are often the last to be tested. There are rising concerns about declining sperm quality, with roughly 30 – 50% of infertility cases involving male factor issues.  

The first step is a sperm sample which is then analysed to look at the volume and quality of the sperm, including sperm shape, movement, pH, volume, liquefaction, sperm count, and appearance.  

If your results come back normal, your doctor may request additional tests such as a semen culture or sperm DNA fragmentation test. 

• Sperm DNA fragmentation: This looks at the genetic integrity of the sperm. High fragmentation means the DNA is damaged, which is a common cause of “unexplained” infertility and recurrent miscarriage. 

• Semen Culture: This checks for “silent” infections that might be hindering sperm function without causing any obvious symptoms. 

4. Auditing your modern environment 

We live in a world full of natural and man-made chemicals that can mess with our body’s natural hormone system. If you are struggling to conceive, it’s worth looking at your daily habits. It isn’t about being perfect, but it’s worth trying to reduce the toxic load that might be interfering with your body. 

• For everyone: Switch to a Mediterranean-style diet (lots of antioxidants), ditch the vapes, and try to cut down on plastics, especially when heating food. 

• For men: Sperm hates heat. Keep the laptops off your lap, stay out of the sauna, and swap the tight briefs for loose-fitting boxers. 

• For women: Focus on sleep and weight management to keep your ovulation cycles as regular as possible. 

5. Check for hidden immune or endometrial issues

Sometimes the embryo is perfect, but the womb lining isn’t ready. If you’ve had failed IVF cycles or miscarriages, there are advanced tests that look at the environment of the uterus: 

• ERA: Checks if we are transferring embryos at the exact right time for your body. 

• EMMA & ALICE: These look for healthy bacteria and check for chronic inflammation or infections in the lining of the womb. 

• NK cells: Evaluates “natural killer” cells. While still a developing area of science, some believe an overactive immune system might interfere with an embryo from implanting. 

What are your next steps? 

The NHS is a fantastic resource, but the waiting lists for these tests can take years. If you need fast answers, a private fertility assessment is often the quickest route. 

When choosing a clinic, don’t just look at the glossy brochures. Check the HFEA website. They are the UK’s independent regulator, and you can see real success rates and inspection reports for every clinic in the country. 

If you want to move past the “unexplained” label, we are here to help. You can book an assessment with Dr. Wael Saab and our team at CRGH by calling 020 7837 2905 or book your consultation here. 

Let’s find the answers together.