Unexplained Infertility After IUI: What to Do Next

For couples trying to conceive, experiencing unexplained infertility can be an emotionally challenging journey. This frustrating diagnosis occurs when fertility tests reveal no obvious cause for the inability to get pregnant, even after fertility treatments such as intrauterine insemination (IUI).

What is unexplained fertility?

Unexplained infertility means that doctors can't find a clear reason why a couple is having trouble getting pregnant, even after running various tests. This diagnosis is only given after both partners have gone through thorough fertility evaluations.

How is unexplained infertility diagnosed?

There isn't one fertility test that can diagnose every possible cause of infertility. And testing methods aren't 100% accurate either (for example, they may not detect mild abnormalities). Fertility testing should include:

1. A complete medical and sexual history.

2. A physical exam.

3. Blood tests to look at hormone levels.

4. Semen analysis.

5. Ovarian reserve testing.

6. Checking your ovulation.

If a fertility specialist or obstetrician performs comprehensive testing and still can't find a cause, they may diagnose it as unexplained infertility. It’s important to note that every provider may have a different protocol for fertility testing, so it's OK to get a second opinion if you receive an unexplained infertility diagnosis.

Understanding unexplained infertility

Unexplained infertility is diagnosed when you and your partner have no known fertility problems such as low sperm or egg quality. You also don’t have conditions like endometriosis or polycystic ovarian syndrome. In addition, fertility tests show that you have:

1. Normal ovulatory function

2. Healthy uterine cavity

3. Open fallopian tube

4. Normal semen analysis

Despite these seemingly normal results, couples with unexplained infertility have a significantly lower fertility rate of 2% to 4% per menstrual cycle, compared to 20% to 25% for fertile couples.

It's important to have a thorough consultation with your fertility specialist to determine if IUI is suitable for you. Request a consultation with our fertility specialists at Thomson Fertility Centre for personalised recommendations and tailored advice.

IUI and unexplained infertility

Intrauterine insemination (IUI) is a type of fertility treatment that helps to increase your chances of pregnancy by placing your partner’s sperm directly into your womb. This procedure is less invasive and more cost-effective compared to other fertility treatments, such as in vitro fertilisation (IVF).

IUI is usually recommended as part of initial treatment for couples facing fertility issues such as unexplained infertility, reduced sperm count, or cervical complications. To increase the chance of conception, this procedure is best performed during one's natural ovulation or with superovulation with IUI (SO-IUI).

For couples with unexplained infertility, IUI success rates typically range from 10% to 20% per cycle for women under 35. However, IUI in natural cycles only marginally increases the pregnancy rate to about 5%. Therefore, IUI is often combined with ovarian stimulation to improve success rates.

Coping with failed IUI attempts

Failed IUI attempts may be due to ovulation problems, fallopian tube blockages or age-related decline in fertility. Facing unsuccessful IUI cycles can be emotionally taxing. 

Here are some strategies to help cope:

Seek support

Connect with others experiencing similar challenges through support groups or online communities, such as Fertility Support SG and I Love Children (ILC). 

Click this link to find out more information on fertility support options in Singapore.

Practice self-care

Engage in activities that promote relaxation and reduce stress.

Communicate openly 

Use techniques like "The Twenty Minute Rule" to discuss infertility concerns with your partner.

Stay informed

Gather information about your condition and treatment options to reduce uncertainty.

Consider counselling

Professional counselling can provide a safe space to express feelings and learn coping strategies.

When do I need to consider other fertility methods?

After multiple failed IUI attempts, couples may consider alternative treatment options:

• In vitro fertilisation (IVF): 

  • This procedure involves fertilising eggs outside the body and transferring embryos to the uterus.

• Intracytoplasmic sperm injection (ICSI): 

  • A specialised form of IVF where a single sperm is directly injected into an egg.

While dealing with unexplained infertility can feel like navigating a maze, staying informed, seeking support, and maintaining open communication with your partner can help you manage this challenging experience.

It's crucial to remember that unsuccessful IUIs don't necessarily mean the end of your fertility journey. Consult with your healthcare provider to explore the best path forward based on your specific situation.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please book an appointment with Thomson Medical to consult a specialist today.

FAQ

Is it possible to get pregnant with unexplained infertility?

Yes, it's possible to get pregnant if you're diagnosed with unexplained infertility. A diagnosis of unexplained infertility doesn't mean you have to give up your dreams of a baby.

How effective is IUI for unexplained infertility?

If we assume the chance of a live birth with expectant management in a natural cycle was 9%, the chance of a live birth with IUI in a stimulated cycle would be between 17% and 50%.

What are the odds of getting pregnant with unexplained infertility?

The chance of getting pregnant with unexplained infertility depends on several factors, including your age and the length of infertility.

Is IVF more successful with unexplained infertility?

IVF as a first-line treatment for unexplained infertility patients demonstrates a higher pregnancy rate compared to patients that undergo IUI then IVF. However, IUI is often recommended as the first treatment for infertility.

Why would an IUI be unsuccessful?

You need a high-quality sperm cell and egg to create a pregnancy. As a result, many IUI attempts fail because of poor egg quality, hindering the fertilised egg from developing into a healthy embryo and further into a healthy pregnancy.

Can I get pregnant naturally after a failed IUI?

Yes, it is possible to get pregnant naturally after a failed IUI. While a failed IUI cycle can be disappointing, it does not eliminate the chances of natural conception in future cycles.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Book an appointment with Thomson Medical today.