Why a diagnosis of unexplained infertility isn't all bad news

Getting a diagnosis of unexplained fertility can be difficult and frustrating, but it's not all bad news.
Getting a diagnosis of unexplained fertility can be difficult and frustrating, but it's not all bad news. Photo: Getty Images

"So, what we can conclude from all our tests, is that you have what is known as unexplained infertility," explained the doctor. 

It was a shock to both of us. We had been expecting the worst, of course, something along the lines of cysts on my ovaries, or a diagnosis of weak swimmers on my husband's behalf. But unexplained infertility? This certainly wasn't something that we had planned for or expected. In fact, up until that point, I had never even heard of it. Yet, as it turns out, it's a very common diagnosis. 

Michelle Tarner* and her partner were also diagnosed with unexplained infertility following two years of trying to conceive naturally.

"My partner and I decided we were 'open' to conceiving in May 2012," she says. "By the beginning of 2014, we were more actively trying to conceive, so were watching our diets, taking vitamin supplements and trying out charting. I decided to speak to my doctor in February 2014 as I realised it was getting close to two years with no luck."

Tarner initially felt quite dismissive of her diagnosis, describing it as "not a real diagnosis, but rather a lingering question mark". It was also challenging for her to accept that she was trapped in a limbo land of uncertainty regarding her fertility, when she had dreamt of having children since being little herself.

"On the flipside, I was able to maintain hope that a natural conception was still around the corner, and also thanked my lucky stars that my partner and I had not been diagnosed with a condition that would leave us with fewer options or more difficult choices," she adds.

According to Dr David Knight from Demeter Fertility, unexplained infertility, also called idiopathic infertility, accounts for the proportion of couples where investigations haven't shown any obvious cause for the issue.

Dr Knight says that in the 1980s, this accounted for around 50 per cent of couples, but as medical knowledge has increased, the proportion diagnosed with this has now decreased to 15-30 per cent.

"This diagnosis is frustrating and sometimes devastating for couples trying to conceive, mainly because we seek to understand why we're not getting the outcome we wish for," says Dr Knight.


"With no clear idea what's delaying pregnancy, many couples choose to look at this diagnosis as though it implies 'there is nothing wrong'," he explains. "But this can be a very unhelpful approach, as it is generally associated with longer delays in seeking treatment."

Genea Fertility's counsellor, Christine Singleton, says that frustration is the most common reaction she sees in couples with this diagnosis. It all stems from the lack of having something tangible to fix.

"When couples get a diagnosis of a male or female infertility factor, although it is essentially bad news, many of them see it as a positive because they know what the problem is," explains Singleton. "Couples with unexplained infertility don't get delivered a reason for their infertility, so they're left with no resolution and a feeling that they're no closer to fixing the problem, because it can't be identified."

Singleton says that during counseling sessions she encourages patients to ask any and every question that they can think of, with the aim of easing their minds.

However, in some instances, unexplained infertility can lead couples to jump to worst-case scenario conclusions.

"Patients will spend time searching Google to try to fill in the gaps medically and emotionally," says Singleton. "And for some, this can raise questions that can be quite challenging as a couple, such as whether they are a good combination and whether they should be even having children together."

Singleton explains that the biggest thing for people to remember is that they're not alone, and that there are many that have experienced these problems before.

"I advise patients to keep an open mind while pursuing treatment options, and remember that treatment cycles can be diagnostic. So while you may not be successful, the outcomes may bring you and your fertility specialist closer to a solution."

While it may seem unbelievable, it's not all doom and gloom – there are actually some positives to this diagnosis. 

"Unlike infertility due to a male or a female factor, unexplained infertility is a shared diagnosis, so can reduce or eliminate the potential for blame between a couple," explains Singleton. "It gives them the potential to take on the challenge together, supporting each other and actually growing closer."

And that's not the only upside: as there's no specific infertility factor, each test and treatment can provide more information, hopefully leading towards a solution, and couples are able to keep trying naturally in between treatment cycles.

It also means that other options are still open to investigation and improvement in between treatments, such as general health and wellbeing. 

As for the future of this diagnosis, Dr Knight feels optimistic.

"Of all of the infertility diagnoses, this is the one that comes with the highest success rate in achieving the desired outcome of a baby," he says. "It also means there are better pregnancy chances with fertility treatment, and there's always the background chance of spontaneous pregnancy."

And spontaneous pregnancy is exactly what happened to Michelle Tarner after her diagnosis.

"Much to our surprise and delight, I fell pregnant in October 2014, around three months after commencing some of our own 'natural' measures," she says. "We never gave up or lost hope."

"For me and my partner, being diagnosed with unexplained fertility was the start of a learning process that we took at our own pace – and thankfully followed to a successful conclusion."

* Last name changed.