Dr. Lester De Silva asked:


Background

Definition of unexplained infertility: Infertility cases in which the standard infertility testing has not found a cause for the failure to conceive.

The definition of what “standard testing” consists of is not agreed upon by all experts. Unexplained infertility is also referred to as idiopathic infertility. Medical studies have reported that 0-26% of infertile couples have unexplained infertility. The most commonly reported figures are between 10-20% of infertile couples. However, those percentages are from studies in which all the women had laparoscopy surgery to investigate the no longer done as part of the routine fertility workup. Therefore, we are not finding all of the causes of infertility that we used to – leaving more couples in the unexplained category. The current rate of unexplained infertility is probably about 50% for couples with a female partner under age 35 and about 80% by age 40 (see discussion below about female age issues).

In reality, there are probably hundreds of “causes” of infertility. What this means is that there are a lot of things that have to happen perfectly in order to conceive and have a baby. As a simplified example:

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 must rupture and release the follicular fluid and the egg The tube must “pick up” the egg The ***** must survive their brief visit in the vagina, enter the cervical mucous, swim to the fallopian tube and “find” the egg The ***** must be able to get through the cumulus cells around the egg and bind the shell (zona pellucida) of the egg The ***** 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 into the uterus The embryo must continue to develop into a blastocyst The blastocyst must hatch from 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…

 A weak link anywhere in chain can this cause failure to conceive

The above list is very oversimplified, but the point is made. There are literally hundreds of molecular and biochemical events that have to function properly in order to have a pregnancy develop. The standard tests for infertility barely scratch the surface and are really only looking for very obvious factors, such as blocked tubes, abnormal ***** counts, ovulation regularity, etc. These tests do not address the molecular issues at all. That is still for the future…2

The subtle causes of sub fertility that have been proposed as underlying unexplained infertility are as follows3

Ovarian and endocrine factors

 Abnormal follicle growth

Luteinized unruptured follicles and ovarian cysts

Hyper secretion of LH

Hypersecretion of prolactin in the presence of ovulation

Reduced growth hormone secretion /sensitivity

Cytological abnormalities in oocytes

Genetic abnormalities in oocytes

Antibodies to zona pellucida

  Peritoneal factors

 Altered macrophage and immune activity

Mild endometriosis

Antichlaydial Ab

  Tubal factors

 Abnormal peristalsis or cilliac activity

Altered macrophage and immune activity

  Endometrial factors

 Abnormal secretion of endometrial proteins

Abnormal intergrin/adhesion molecules

Abnormal t cell and natural killer cell activity

Secretion of embryo toxic factors

Abnormalities in uterine perfusion

 Cervical factors

 Altered cervical mucous

Increased immunogenicity

General immune factors

Altered cell mediated immunity

  Male factors

 Reduction in motility, acrosome reaction, oocyte  binding ,and zona penetration

Ultrasructural abnormalities of head morphology

  Embryological factors

 Poor quality embryos

Reduced progression to blastocyst

Abnormal chromosomal complement-increased miscarriage rate

Unexplained infertility and female age

Women are born with certain number of eggs and when they attain menarche they start releasing these eggs cyclically. As the woman ages they run out of there eggs and quality of eggs will become poorer too. Therefore the likelihood of a diagnosis of unexplained infertility is increased substantially in women 35 and over – and greatly increased in women over 38. Since we do not have a “standard category” called egg factor infertility, these couples sometimes get lumped in to the “unexplained” infertility category. Most women over 40 who try to get pregnant will have difficulty, and fertility over age 44 is rare – even in women who are ovulating regularly every month. The point is that the older the female partner, the more likely that there is an egg related issue causing the fertility problem. Unfortunately, there is currently no specific test for “egg quality”.2

Unexplained infertility and Mild endometriosis

It is not quite clear whether mild endometriosis causes infertility and treating mild endometriosis improve the fertility rates. Some recent studies has shown surgical treatment for mild endometriosis increases the fertility. Some experts would also consider infertility associated with mild endometriosis to be in the “unexplained” category. This is because a cause and effect relationship has not been definitely established between mild endometriosis and fertility problems.

Chance for getting pregnant on own – without fertility treatment – for couples with unexplained infertility

The duration of infertility is important. The longer the infertility, the less likely the couple is to conceive on their own. After 5 years of infertility, a couple with unexplained infertility has less than a 10% chance for success on their own.

One study showed that for couples with unexplained infertility and over 3 years of trying on their own, the cumulative pregnancy rate after 24 months of attempting conception without any treatment was 28%. This number was found to be reduced by 10% for each year that the female is over 31.4

Treatment options for unexplained infertility

Ovarian stimulation and/or intrauterine insemination (IUI)

Intrauterine insemination vs. timed *********** – no medications involved

Studies have been shown that chances of pregnancy is increased with intrauterine insemination  compared to timed ***********.

Clomid and timed intercourse

Glazener et al .treated 100women,43% of whom were porous ,with either clomid 100mg from days 2-6 and placebo in a randomized cross over study. Overall there was a 50% increase in pregnancy rates after 3 cycles of treatment. Benefit was seen in after 3 years of infertility and more so in parous women.The same study showed that there were no conception in women over 35 years.5 This suggest that these women are not suitable candidates for clomid treatment and should be treated vigorously with assisted conception methods.

Clomid plus IUI

Treatment with Clomid tablets plus IUI improves fertility rates. For unexplained infertility, studies have shown that for women under 35, monthly success rates for Clomid plus insemination are about 10% per cycle. This pregnancy rate holds up for about 3 tries and the success rate is considerably lower after that.

Deaton et al carried out a randomized study between timed *********** or clomid with IUI, and showed that monthly fecundity was 9.5% in clomid plus IUI group compared to control group- a significant difference.6  In the same study it has been showed that there was no difference in number of follicles between conception and non conception cycles, suggesting that the insemination component have a more important influence than the Clomid does on outcome- but success rates are higher when both are used together.

Collating all studies together a recent systematic review, Hughes et al. reported that treatment with clomid is superior to no treatment or placebo (95% CI 1.5-4.65).7

Injectable gonadotropins plus intercourse

This is less extensively studied. However a study by Mascarenhas et al demonstrated that super ovulation with gonadotrophins significantly increased the pregnancy rates in unexplained infertility.8

Injectable gonadotropins (shots of FSH hormone) plus IUI

Several studies showed improved pregnancy success rates with injectable FSH plus IUI treatment as compared to no treatment. A meta-analysis by Hughes9 indicated that FSH plus IUI increases the pregnancy rate by 2.3 times than compared to FSH plus timed ***********.

It is most likely that super ovulation and IUI  both independently increase fertility potential, with relatively more fertility benefit coming from the IUI component.

Assisted reproductive technologies

IVF

In vitro fertilization (IVF) has high success in young women with normal ovarian reserve (normal FSH levels) and unexplained infertility. Most couples with unexplained infertility with a female partner under age of 35 could try about 3 artificial inseminations and if fail to pregnant  it is sensible to have IVF. On the other hand women over 35 years should have been offered IVF as a first line treatment.

GIFT

Gamate intrafallopian transfer goes one step further than superovulation/IUI as it involves the collection of oocytes and ***** into fallopian tubes. The main disadvantage compared to IUI is the need of laparoscopy and more complicated ovarian stimulation regimes. Compared with GIFT the main advantages of IVF are, that being able to study the fertilization, gives the opportunity to transfer best quality embryos to the uterus, and it also gives couple with surplus fertilized oocytes which can be cryo preserved for future use.

A large multi-center randomized study performed by European Society of Human Reproductive and Emryology to compare five treatments for unexplained fertility .The study concluded that there was no significant difference in outcome between them.(super ovulation 15% per cycle, super ovulation 27%,superovulation/IUI 27%,GIFT28%,IVF26%.10

 In summary, strategic management of unexplained infertility should focus on the efficacy of the method ,cost effectiveness and invasiveness of the procedures involved. Evidence suggest that there would be little or no benefit if treatment start in  a woman less than 35 years. Therefore it is worth considering superovulation and/or IUI for 3 cycles after 3 years of infertility, and if not successful go for IVF. However for older women (over 35) to consider IVF straight away.

References

1. Hull MGR, Glazener CMA, Kelly NJ et al.(1985), Population study of causes,

2. Unexplained Infertility

http ;//www.advancedfertility.com/unexplain.ntm( accessed 11/03/2008).

3. Adam, H.B. & Howard, S.J, (2003), Infertility In Practice, Churchill Livingstone, London.

4. Collings JA ( 1989), Natural course of unexplained infertility, Proceedings of the Serono symposium on unexplained infertility : basic and clinical aspects. Serono Aries Publishers, Rome.

5. Glazener CMA, Coulson C, Lambert PA et al, ( 1990), Clomiphene treatement for women with unexplained infertility : placebo-controlled study of hormonal responses and conception rates. Gynecol Endocrinol 4: 75-83

6. Deaton JL, Gibson M, Blackmer KM, Nakajima ST, Badger GJ & Brumsted JR, (1990), A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis. Fertil Steril 54 : 1083- 1088.

7. Hughes E, Collins J, & Vandekerchhove P (2002),Clomiphene citrate for unexplaine subfertility in women. Cochrane Database of systematic Reviews, Issue 1, 2002.

8. Mascarenhas L, Khastgir G, Davies WAR & Lee S, ( 1994),Superovulation and timed intercourse: can it provide a reasonable alternative  for those unable to afford assisted conception ? Hum Reprod  9: 67 -70

9. Hughes EG (1997), The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility : a meta-analysis. Hum Reprod 12 : 1865-1872

10. Crosignani PG, Walters DE & Soliani A, (1991), ESHERE multicentre trail on the treatment of unexplained infertility : a preliminary report. Hum Reprod 6: 953-958.



Alice

Cindy Heller asked:


When it comes to traditional Chinese medicine and infertility, both the herbs and acupuncture are essential in order for the medications to be effective. The idea behind it is to treat the imbalance in the body through the use of acupuncture and herbs as they will restore the disharmony.

With alternative source of treatment, the conventional infertility treatments and traditional Chinese medicine must be combined. The traditional Chinese medicine and conventional infertility treatments can be are used when all avenues are exhausted as it will lead to a higher possibility of conceiving.

Acupuncture has existed for many centuries in certain cultures as a mean of treating all form of diseases. Acupuncture assists in regulating the flow of blood by the stimulation of the central nervous system as neurotransmitters and neurohormones are released as a result which help to heal the body.

In addition to, acupuncture discharge endorphins which help to fight pain; giving rise to a sensation of wellness. In the East where it was found and even in the west, acupuncture is used to treat a variety of conditions and the association between acupuncture and infertility is still being studied.

Although acupuncture may seem an odd treatment for infertility, it has become increasing popular in helping infertile couples. The idea that needles are used can be discomforting but it is just a painless process of treating infertility. Just like an ant bite and slight bruising might occur but in general, acupuncture causes no major discomfort. Other form of infertility treatment cause more discomfort than acupuncture treatment, so there is nothing to worry.

The use of acupuncture for infertility is effective because our body have energy channels and they flow to different portions of the body and the surface of the body. With blockages, the energy flows are impeded and acupuncture will free the obstructions. With the release of chemicals into the muscle, brain and spinal, the healing is in process. Acupuncture has proven to assist in certain areas that normal infertility treatments are not able to.

Before embarking on acupuncture or alternative treatment, there is a need to consult your infertility physician and if the physician found out from the infertility tests that the problem is structural; then the combination of both traditional acupuncture and herbs treatment together with infertility treatment will not be helpful.

Knowing the cause is essential to treating infertility and acupuncture is a good start. The focus will be on three vital organs and they are kidney, spleen and liver as they have a direct bearing on the reproductive organs. Traditional Chinese medicine concentrate on these three organs and acupuncture will directly impact the reproductive organs through the treatment of these three organs.

Herbal supplements go well with traditional Chinese medicine by enhancing infertility treatment. Disharmony in the infertility treatment will be assisted by consuming herbal medications. Stress and anxiety can be reduced by their use and all in all, the treatment will improve the chances of conceiving.

As acupuncture is mostly used in treating infertility problem such as hormonal imbalances, structural abnormalities such as blockages of the fallopian tubes cannot be treated with acupuncture. With acupuncture, the body system is regulated and more blood flow to the vital organs and help in the regulation of the hormones. That will provide sufficient time for the body to recover especially for matter such as hormones imbalance. Acupuncture is best after conventional form of treatment are tried and in combination with such treatments.

As herbal supplements are sometimes used with acupuncture to boost acupuncture treatments and assist in curing infertility but certain herbs do impede the effect of infertility pills, so it is wise to consult your physician. Acupuncture is most effective when female is having the in vitro fertilization cycle. As acupuncture assist in calming the body as well as reducing anxiety, adding to in vitro fertilization success.

As there is an effective link between acupuncture and infertility, so it will be beneficial to look at the treatment. Just scheduling a few sessions may contribute to conception.

One of the best alternative forms of infertility treatments is acupuncture but it is better to find out more before using it and traditional form of treatment is very effective with acupuncture. Although traditional form of treatment is still controversial, there is little harm in taking a look after all else fail. Acupuncture as a form of treatment is worth a look at and conception might just occur.



Allan

Leokadia Angela asked:


If you’re someone facing the difficult diagnosis of infertility, you may be ready to start undergoing all the painful and expensive treatments and invasive surgeries that your doctor has recommended. But is this your only option? What about trying some natural herbs for infertility; do these work? If so, what are they? And are there any other natural supplements that one can at least try first, before undergoing all those unpleasant procedures?

Vitamins and Minerals for Treatment

When thinking about what herbs for infertility actually work, you may want to consider what some experts are saying about natural treatments, including vitamins and other such substances. In a new study cited in OBGYN News, a group of Harvard researchers found that 79% of infertile couples had a lower-than-average intake of foods high in antioxidants – like fruits and vegetables.

In one study published in the Annals of the New York Academy of Medicine, doctors found that after one week of daily doses of 1,000 milligrams of vitamin C, ***** counts rose by some 140%. If you’re thinking of trying some herbs for infertility, consider something with a vitamin C supplement.

More recently, a study published in the Archives of Andrology showed the antioxidants vitamin E and selenium improved the ability of ***** to swim : a skill necessary to reach the egg.

Homeopathic Herbs for Infertility

There are some great homeopathic remedies that include herbs for infertility, and some are actually catching the attention of traditional doctors. ‘In research published in the journal Reproductive Biomedicine Online, a group of German doctors show that some natural remedies may work for men. The authors show that ***** quality and function improved with the intake of complementary food supplementation using either a combination of zinc and folic acid, the antioxidant Astacarox, or an energy-providing combination containing (actyl)-carnitine (Proxeed). The latter two also boosted the success of intrauterine insemination and spontaneous pregnancy rates.’ These substances are common in homeopathic herbs for infertility.

Moreover, in the journal Fertility and Sterility doctors reported that men with fertility problems who took a daily dose of 66 milligrams of zinc and 5 milligrams of folic acid for nearly six months saw a 74% increase in their ***** counts.

Even more recently, studies published in the journal Fertility and Sterility revealed that both L-carnitine and L-acetyl carnitine improved ***** in a number of areas key to fertilization.

The following remedies are considered potent herbs for infertility in women:

sepia 6c: used to treat irregular or absent ovulation

sabina 6c: recommended for women who have suffered recurrent miscarriage

aurum:used when lack of *** drive and depression are thought to be the cause of infertility

silica: this remedy is used to boost a woman’s weakened immune system

phosphorus:used to treat stress as well as emotional anxiety that can accompany infertility

The following remedies are considered potent herbs for infertility in men:

sepia 6c is used to treat low *** drive

medorrhinum: this homeopathy treatment is believed to help treat impotence



Jack

Low Jeremy asked:


A medical problem that has plagued couples from a generation to the succeeding ones. There is too less mystery involved in infertility. Nevertheless, there are still areas that need polishing such as with the case of unexplained infertility.

Infertility is normally diagnosed if a couple is not able to produce a single pregnancy in a span of a year given that they commit sexual *********** that is unprotected. It may either be that the male participant is infertile or the female. Condition may be permanent and irreversible. However, there are cases when infertility is remedied by means of surgical intervention, medication and natural methods that promote fertility.

If you are wondering why infertility seems to cling into many couples, then let us understand that infertility is a three-part problem. One part being equal to the other two. All shared by the three factors namely, problems with the male participant, the female participant and the third portion is either distribute between the two former factors or unexplained, even by the vast knowledge science holds.

While infertility is mainly focused on medical issues, it is psychologically devastating as well. It forms a struggle between the willingness of the couple to undergo certain procedures to be able to promote fertility. It also creates stress on the relationship. Thus, it may eventually dissolve a good relationship.

These issues aside, we can presume that it is also physically distressing. It is taxing to endure examinations and physical tests on a yearly, monthly and even daily basis. Daily injections may even be required. Medications may cause both subtle and obvious side effects that may alter the normal life of the couple enduring them. Surgery, on the other hand, is often required and sometimes infertile couples have to undergo several procedures without the absolute assurance that those will work.

As these processes continue, the couple’s privacy will become very limited to them alone, sometimes even personal privacy is invaded. They have to learn to discard their own emotions for the sake of producing a pregnancy. They have to forget their own feelings of shame and fatigue as they lie on the examining table, have some fluid and give sperms or egg cells for the 8th, 10, 15th and so times. A vacation would do, yes, even for a month. Just to let the couples rest. However, with every day that passes and every procedure failed, the chance of conceiving a child is getting less and less feasible.

It is truly an alternative medicine only for the reason that it is not based on western knowledge. If this is our basis of categorizing what is effective medicine and what is not, it would be a bit unfair for all oriental medical methods that work. Though not all quick fixes are convincing and real, acupuncture may be one of the selected few that really creates satisfying and immediate results.

Not only does acupuncture when used in conjunction with other infertility methods effective, it may also induce relaxation and absence of pain throughout the procedures. The main principle standing in methods used in acupuncture is the release of energy blockages in certain parts of the body. Energy must flow and it must flow well. If there is any clog that will affect its smooth travel to the body, the only option to unleash them is the insertion of needles in specific points where energy is particularly blocked thus the occurrence of certain diseases.

A close look at acupuncture treatment will reveal that each plan for treatment is different from the next. This is because patients posses varying physical problems that must be addressed accordingly. A consensus among practitioners and patients maintains that acupuncture works at its optimum when all other means were already completed but in vain. Acupuncture for infertility is also ideal for couples who would not want taxing themselves financially with more extensive treatments such as those that require a number of physical examinations, tests and even surgeries.

This also works best for patients suffering from specific diseases such as irregular ovulation for women and ***** duct blockage. Acupuncture treatment for infertility may come in three techniques namely manual, electrified and auricular. Electrified method means the use of electric needles to clear the passages of energy. Auricular method, on the other hand, entails the use of pricking the earlobes and the ears so as to clear hormonal disorders especially in women.

While many may claim that acupuncture for infertility is a cure, it would still be safe to say that it is an important part of any treatment conducted to infertile couples.



Ricky

Darrell Miller asked:


Infertility is typically defined as a failure to conceive after a year or more of regular intimate activity during the time of ovulation. This term can also refer to the inability to carry a pregnancy to term. About 6.1 million American couples are impaired when it comes to their ability to have children, with 2.1 million of these couples being infertile. The exact cause of the problem can be extremely difficult to pinpoint, as ovulation, fertilization, and the passage to the fertilized ovum through the fallopian tube and to the uterus are extremely complex processes. In order for pregnancy to occur, many events must work together perfectly.

In 40 percent of infertile couples, problems that affect the male partner are either partially or wholly the cause of infertility. Infertility in men is usually the result of a low ***** count or an anatomical abnormality. There are a variety of factors that can result in a low ***** count. Among these factors are alcohol consumption, endocrine disorders, exposure to toxins, radiation or excessive heat, recent acute illness or prolonged fever, testicular injury, and rarely, mumps-induced wasting of the *********. An abnormal enlargement of veins that drain the testicles, referred to as varicoceles, can cause infertility in men. This is because the veins of the testes are no longer able to moderate the temperature of the ********* correctly, which can negatively affect *****.

The most common causes of infertility in women include an ovulatory failure or defect, blocked fallopian tubes, endometriosis, and uterine fibroids. Additionally, some women are able to develop antibodies to their partners’ sperm, which causes the woman to almost be allergic to them. Chlamydia, a transmitted disease which affects 4 million Americans each year, also causes many cases of infertility. There are also psychological issues, such as stress or fear of parenthood, which can also contribute to infertility.

However, in most cases, stress is usually the result of infertility, not the cause of it. ***** abnormalities account for about 41 percent of infertility cases. The following reasons are the most common to explain why couples cannot conceive: the woman has endometriosis; the man has abnormal sperm, a low ***** count, or erectile dysfunction; the woman’s fallopian tubes are blocked; ovulation takes place rarely or irregularly; the couple is unable to have complete intimate relations; the cervical mucous attacks and kills the sperm; the woman does not manufacture enough progesterone to carry a baby to term; the woman is over thirty-four; and/or one or both members of the couple eats a poor diet and experiences too much stress.

The following nutrients are extremely beneficial in helping one or both partners deal with infertility: selenium, vitamin C with bioflavonoids, vitamin E, zinc, DMG, octacosanol, phosphatidyl choline, essential fatty acids, l-arginine, manganese, proteolytic enzymes, pycnogenol, raw orchic glandular, raw ovarian glandular, 7-keto DHEA, vitamin A, and vitamin B complex. Also, the following herbs have been shown to be beneficial in dealing with infertility: astragalus, damiana, ginseng, sarsaparilla, saw palmetto, yohimbe, dong quai, false unicorn root, gotu kola, licorice root, wild yam root, green oat, and yin-yang-huo. It should also be noted that heavy use of Echinacea, ginkgo biloba, and St. John’s wort may cause infertility in men, and should be avoided.

Infertility can be a complicated and mentally depressing due to lack of pregnancy by both men and women. Depression can lead to more stress and needs managed by a health care provider. Always consult your doctor when you think you are infertile. Natural vitamins like the ones listed above are available at your local or internet health food store. Look for name brands vitamins to ensure you receive quality supplements.

*Statements contained herein have not been evaluated by the Food and Drug Administration. Vitamins and herbs are not intended to diagnose, treat and cure or prevent disease. Always consult with your professional health care provider before changing any medication or adding Vitamins to medications.



Alex