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Idiopathic infertility. What to do if the cause of difficulties in getting pregnant is unknown?

According to estimates, depending on the woman’s age, from 50% to as many as 80% of all couples trying for a child struggle with the so-called idiopathic infertility, that is, experience problems with conception, despite the fact that routine fertility tests they underwent have not revealed any significant deviations from the norm. 

The longer the couple wishing to have a child fails to obtain pregnancy without medical support, the lower their chances of becoming parents - after five years of unsuccessful attempts at pregnancy, the probability of conceiving a child falls below 10%. This is why it is so important to take effective action at the earliest possible stage of attempts at enlarging the family.

Why can’t we have a child?

Doctors have calculated that on the day of ovulation, the most fertile day of the cycle, a healthy woman has maximum 30% chances for becoming pregnant. What's more, even if conception occurs, there is no guarantee that the embryo will implant in the uterine cavity and will develop properly for the entire nine months. Statistical data show that every fifth pregnancy ends with a very early miscarriage in the first trimester, usually before the woman is aware that she’s going to be a mother.

The causes of spontaneous abortion at an early stage of pregnancy vary. Due to the fact that the process of formation and implantation of the embryo in the uterine cavity occurs in multiple stages, and even a slight deviation from the norm may disturb it, getting to the source of the problem can be quite a challenge.

Statistically, a specific cause of infertility is determined in about 20-50% of cases; in other couples the standard diagnostic tests carried out in infertility are not yet able to name the “main culprit”. This does not mean, however, that couples struggling with idiopathic infertility are left alone - on the contrary, despite the lack of a precise diagnosis, they can and should be treated.

What to do when the cause of infertility is unknown?

If a woman is less than 35 years old, doctors often decide to use clomiphene citrate (a drug that stimulates ovulation - instead of one egg, there are two or three) in combination with intrauterine insemination. At the first three attempts, the percentage of pregnancies obtained is 10%, and then clearly decreases in the following months.

Another method of treating idiopathic infertility is to administer the FSH injection prior to insemination. Injections can also be used without additional support in the form of assisted reproduction techniques, but the effectiveness of such procedure has not been yet thoroughly examined.

IVF and idiopathic infertility

It is known, however, that in the case of idiopathic infertility with normal ovarian reserve, in vitro fertilisation produces good results. At present, insemination in idiopathic infertility is used with decreasing frequency - especially in women over 35 years of age.

The age of a female patient who wants to have a child is of enormous importance when choosing a method of treatment explains Łukasz Sroka, MD, a specialist in gynaecology and obstetrics from the InviMed Fertility Clinic in Poznań. - With each month, the ovarian reserve diminishes, and the quality of egg cells deteriorates, further reducing the chances of pregnancy. When you turned forty, it's really not worth wasting time on ineffective methods or, what’s worse, sit idle the doctor adds.

Sometimes the cause of infertility which has been unknown can be detected at one of the stages of IVF procedure; for example slow embryo growth. This means that in addition to the therapeutic role, the IVF procedure may also have a diagnostic function, although - obviously - this is not its main purpose.

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