How "unexplained" is unexplained?

Per Wikipedia, the definition of unexplained infertility is: "infertility that is idiopathic in the sense that its cause remains unknown even after an infertility work-up, usually including semen analysis in the man and assessment of ovulation and fallopian tubes in the woman."

In my personal opinion, there is just not enough discussion or information/support for those with this diagnosis.  In my effort to provide as much as possible, all in one spot, I took it upon myself to gather and spew.  Doesn't that sound exciting and educational? :-)

To begin with, for anyone that has every been told "just relax and you'll get pregnant", I thought I would start off with a very good description from Advanced Fertility Center of Chicago in which they give "an overly simplified example of the science involved:

• The hormones that stimulate egg development must be made in the brain and pituitary and be released properly
• The egg must be of sufficient quality and be chromosomally normal
• The egg must develop to maturity
• The brain must release a sufficient surge of the LH hormone to stimulate final maturation of the egg
• The follicle (eggs develop in structures called follicles in the ovaries) must rupture and release the follicular fluid and the egg
• The tube must "pick up" the egg
• The sperm must survive their brief visit in the vagina, enter the cervical mucous, swim to the fallopian tube and "find" the egg
• The sperm must be able to get through the cumulus cells around the egg and bind the shell (zona pellucida) of the egg
• The sperm must undergo a biochemical reaction and release their DNA package (23 chromosomes) into the egg
• The fertilized egg must be able to divide
• The early embryo must continue to divide and develop normally
• After 3 days, the tube should have transported the embryo down into the uterus
• The embryo must continue to develop and expand into a blastocyst
• The blastocyst must hatch out of its shell
• The endometrial lining of the uterus must be properly developed and receptive
• The hatched blastocyst must attach to the endometrial lining and "implant"
• Many more miracles in early embryonic and fetal development must then follow..."

NOW, to anyone who says that it's not that hard to get knocked up, show them that.  The miracle of creating life truly is a miracle, no matter if it is done "naturally" or by other means.

So, back to this whole "we don't know why you aren't getting pregnant" crowd...some statistics show that up to 20% of infertile couples have the diagnosis of unexplained infertility.  I don't know about you, but I think that's a pretty significant amount of people!

"Unexplained infertility is a diagnosis of exclusion; it applies when the standard investigation of both the female and male partner has ruled out other infertility diagnoses. The term does not mean that there is no reason for the infertility, but that the reason is unable to be identified at that time..." (Reproductive Genetics)

It seems as though the concern is how much of a proper and in depth evaluation does a patient receive before having the unexplained diagnosis.  Since not all insurances offer coverage for diagnostic procedures and treatments for infertility, doctors are limited (or some don't do various ones for specific reasons) to what they can/not do in order to provide the best and most accurate diagnosis.

According to Fertility Authority, Dr. Norbert Gleicher, a fertility doctor and medical director of the Center for Human Reproduction (CHR), gives "guidelines for a standard infertility evaluation include: a semen analysis, assessment of ovulation, a hysterosalpingogram, and, if indicated, tests for ovarian reserve and laparoscopy.

If the evaluation comes back normal, Dr. Gleicher suggests asking three questions:

• Have you tested my ovarian reserve according to my age?
• Have you made sure that my hysterosalpingogram was correctly interpreted?
• Have you checked me out immunologically?

For patients with unexplained infertility, Dr. Gleicher says he carefully assesses them and most often finds they have one of the following three conditions:

• Premature ovarian aging
• Overlooked tubal disease or endometriosis
• Overlooked immune causes"

There is so much that we don't understand (including doctors) about medicine and our bodies.  Information is constantly reviewed, connected, absorbed, and evaluated in order to learn.  

When someone receives the diagnosis of unexplained infertility, it can be confusing both mentally and emotionally.  Infertility, in and of itself, becomes obsessive, brings about feelings of betrayal and bitterness, and tests strengths you never knew you had.  Therefore, when give an unexplained diagnosis, imagine all that IF brings and increase it ten-fold!

I still have so much that I want to look into for y'all and information I want to make sure is put out there.  So, this might be when I end this post, but I WILL be back with more.  The group of people that come into contact with this diagnosis deserve support, attention, and information just like everyone else.  I plan to do my best and help that happen.  Next time we will cover causes, tests, and the emotional side.

**Have you been diagnosed with unexplained IF?  If so, what tests and evaluations have you had to endure before receiving it?  Have you been given the diagnosis originally but then found out later an underlining cause?  Please share in the comments section and offer words of advice or experience to those that may be embarking on this journey...help them feel they are not alone...we are a community.