What Is Unexplained Infertility? Why It Happens And The Steps You Can Take To Improve Chances Of Conception

Becoming a parent is usually thought of as a natural part of life, yet for many couples, the process isn't that easy. You might have taken every test, monitored every cycle, and done every doctor's recommendation—only to be informed that everything is normal. And yet, conception still doesn't occur. This infuriating and most of the time perplexing experience has a name: unexplained infertility. In contrast to conditions in which the etiology is obvious, unexplained infertility puts couples hunting for answers in reproductive medicine's gray areas. Diagnosis is often both a blessing and a reversal—relief that nothing appears "wrong," but distress that no obvious solution exists.

For most couples, parenthood is a journey of anticipation, planning, and hope. But what is a couple to do when there are normal test results, no medical red flags found by doctors, and yet no pregnancy? This is the frustrating, emotionally draining experience of unexplained infertility—a condition which brings couples more questions than answers.

During an interview with Dr. R. Suchindra, Senior Consultant – Reproductive Medicine, Milann Fertility Hospital, Bengaluru, he states, "Unexplained infertility is when a couple fulfills all the clinical criteria for natural conception—normal ovulation, normal sperm, patent fallopian tubes, and harmonious hormones—still does not conceive after more than one year of attempting to conceive under age 35, or six months above."

This paradox, too often underemphasized in the discussion of fertility, plagues couples around the globe and is becoming a growing public health issue. Infertility itself affects approximately 10–15% of married couples in India, yet as much as 30% of those cases qualify as unexplained. And although the term may sound final, doctors point out it is really more a matter of limitations in testing than an absolute lack of causes.

Why "Unexplained" Infertility Doesn't Mean "Hopeless"?

The phrase "unexplained infertility" may sound daunting, but it's worth recognizing that it doesn't equal a guarantee of impossibility. Rather, it denotes the realm of reproductive science as of today. Physicians claim that the condition is undeservedly named. What appears to be unexplained now can, in the course of time, turn out to be due to minute hormonal variations, egg or sperm quality problems, or even molecular immune responses that current testing cannot possibly measure.

Dr. Suchindra adds that medical technology is a large contributor: "The more sophisticated the diagnostic equipment, the fewer couples are in the unexplained category. Sometimes the cause is just concealed, not missing."

This is an important point because it reinterprets unexplained infertility as an obstacle to overcome—not an impossible one.

Hidden Causes Behind Unexplained Infertility

Though there is no one explanation, studies propose a cluster of underlying factors that could be responsible:

Latent Tuberculosis (Genital TB): Especially in South Asian nations, this latent infection can destroy the endometrium or fallopian tubes without overt symptoms.

Endometriosis and Muted Hormonal Disturbances: Disorders such as endometriosis, insulin resistance, or thyroid disease are not necessarily detected through regular checks but are able to interfere with ovulation and implantation.

Nutritional Deficiencies and Autoimmune Conditions: Deficiencies in some vitamins and minerals, celiac disease, diabetes, or autoimmune diseases like lupus and antiphospholipid antibody syndrome (APS) may interfere with reproductive processes.

Cervical Mucus and Immunological Factors: In certain instances, cervical mucus has antibodies that destroy sperm, a condition referred to as immunological infertility.

Egg and Sperm Quality: Counts of eggs and sperm motility can be measured, but quality is more difficult to quantify. Unhealthy eggs or undetectable sperm defects might be undetectable in routine reports but affect conception.

All of this serves to explain why unexplained infertility is still such a difficult diagnosis—because the causes are usually hidden beneath the surface.

The Emotional Burden of an Invisible Diagnosis

For couples, a diagnosis of unexplained infertility is more than a medical diagnosis—it's a psychological odyssey. A lack of obvious explanation can be followed by cycles of self-blame, anxiety, and uncertainty. There is no one to draw a roadmap for treatment in this situation, as there might be for other conditions, and so patients can feel helpless.

Dr. Suchindra stresses, "This is usually the most difficult aspect for couples. With no cause found, they are left stuck. But here's what to understand: Many couples with unexplained infertility do end up conceiving naturally or with some assisted help."

Support, counseling, and honest communication with the healthcare providers become as crucial as treatments.

Approaches That Can Improve Chances of Conception

The lack of a definite cause doesn't imply there's no hope. Indeed, a combination of lifestyle changes, medical surveillance, and new reproductive technologies usually enhances the chances considerably.

1. The Importance of Time and Patience

On occasion, physicians will suggest a "watchful waiting" plan. Couples who are less than 35 years old can be told to keep trying naturally for several more months and monitor ovulation carefully. Research indicates that spontaneous conception is possible in a high percentage of situations once tension is minimized and timing is refined.

2. Lifestyle Changes That Enhance Fertility

Having a healthy weight, consuming a healthy diet, smoking cessation, reducing alcohol, reducing caffeine intake, and engaging in stress-reducing activities like yoga or mindfulness can provide a conducive environment for conception. While these measures don't "treat" infertility, they improve overall reproductive health.

3. Medical Treatments and Assisted Reproductive Technology (ART)

When waiting and lifestyle modifications are not sufficient, physicians might prescribe treatments like:

• Ovulation stimulation with medication to control or enhance egg release.
• Intrauterine Insemination (IUI), wherein thawed sperm is inserted directly into the uterus when timed properly.
• In Vitro Fertilization (IVF), which circumvents most natural obstacles by fertilizing eggs externally and transferring embryos.
• All of them have varying success rates based on the couple's age, health, and duration of trying.
• Reproductive medicine is developing fast. Genetic testing, artificial intelligence for embryo choice, and better understanding of immunological and metabolic causes of infertility will soon render the "unexplained" status much less frequent.
• "Each year we find new layers of how the body prepares for pregnancy," Dr. Suchindra explains. "Our challenge as clinicians is to bridge that gap between what we know and what remains unknown, so couples can find clarity and hope."
• Unexplained infertility can be a disquieting diagnosis, but it is not an impasse. Many couples still conceive naturally after a few months of waiting, while others succeed by adjusting their lifestyle and by using ART. What this process requires most is resilience, honest communication with the medical team, and the knowledge that reproductive science is continuously evolving.
• As Dr. Suchindra stresses, "The lack of an answer today does not equate to the lack of a solution tomorrow." To couples on this journey, that message can convert doubt into potential.