Unexplained infertility does not mean undiagnosed infertility. Unexplained infertility means that all known diagnoses have been eliminated. When a couple is diagnosed with unexplained infertility, a careful review is conducted of their entire infertility evaluation.
Each test is examined to ensure it was performed correctly and is technically sound. The interpretation and/or conclusion drawn from the results is also examined. Tests with questionable results may be repeated. Further investigation of one or more questionable factors may be conducted. If a thorough review still provides no clues or leads, the next treatment strategy is empirical therapy.
Empirical therapy is treatment based on observation or experience with other infertile couples, rather than on conclusive evidence of what is wrong. The justification for empirical therapy is that it frequently works.
Through the use of Assisted Reproductive Technology (ART), hormonal therapy is combined with either intrauterine insemination (IUI) or in vitro fertilization (IVF).
The purpose of ART is to enhance or bypass as many fertility factors as possible. Sometimes these ART techniques are used to overcome known deficiencies, such as using IVF to circumvent damaged fallopian tubes.
Empirical Therapy Treatments
There are three levels of empirical therapy treatment available. Each level involves a greater time commitment from the patient, but is associated with a higher probability of pregnancy.
Level 1 includes up to 3 cycles of clomiphene combined with IUI, using 100mg/day for 5 days starting on cycle day 5. Transvaginal ultrasound monitoring will be performed. Typically 2 or 3 follicles — fluid-filled sacs containing eggs — are seen. Once the largest follicle is = 18 mm, hCG is given as a single injection and IUI with specially prepared sperm is performed 24 to 36 hours later. The sperm preparation is performed in our onsite andrology lab.
Level 2 includes up to 3 cycles of gonadotropins combined with IUI. Gonadotropins (Gonal-F, Follistim, Bravelle, Menopur, Repronex) are started on cycle day 3 and administered daily as injections. Transvaginal ultrasound monitoring is started after 5 days of treatment and repeated every 1-2 days until 3-6 follicles reach a size of = 18 mm. hCG is given as an injection to induce ovulation and then IUI with prepared sperm is performed 24 to 36 hours later.
Level 3 involves the use of IVF. Gonadotropins are administered as in level 2, but with the addition of Lupron injections. Transvaginal ultrasound and blood estradiol measurements are done according to protocol, with hCG being administered when mature follicles are detected. Transvaginal ultrasound-guided follicle aspiration is performed 36 hours later. The eggs from the follicles are fertilized with prepared sperm in our state-of-the-art IVF lab housed in our Frisco office. Fertilized eggs, or embryos, are transferred into the uterus 3-5 days later. With IVF, further diagnostic information will be obtained, as we are able to observe the fertilization ability of the sperm, and the embryo development prior to transfer. This information may provide clues to a prior undiagnosed infertility factor.