Unexplained infertility is the diagnosis applied to couples who have no identifiable cause for their infertility after a comprehensive infertility evaluation. It implies that a thorough diagnostic evaluation has failed to reveal any specific cause or factor to cause the infertility. Some women with this diagnosis may be able to conceive without any further treatment. The incidence of unexplained infertility is estimated at approximately 15% to 20% of all couples who undergo a standard infertility evaluation. Although infertile women, older than 35 years, with no identifiable cause for their infertility are assumed to have "old eggs" as the reason for their infertility, often these patients are treated as if they had unexplained infertility.

Although the cause of infertility is unexplained, treatment is possible. The treatment includes medical therapy in addition to intrauterine insemination (IUI). However, after age 43, having these treatments are no more successful than not having treatment.

Treatment can be divided into two parts:

• Clomid® is an oral medication that increases the chances that more than one egg will be produced during each cycle. Clomiphene often increases progesterone.
• Intrauterine insemination is a procedure in which sperm are washed, concentrated and placed in the uterus so many sperm will reach the egg(s). The chance of pregnancy is highest during the first two or three cycles of treatment.

2. Gonadotropins, HCG and IUI. If pregnancy does not occur after using Clomid® and IUI, you may be offered another treatment. This treatment combines the use of

• Injectable gonadotropin hormones such as Repronex. These powerful hormones stimulate the ovaries to produce multiple eggs.
• HCG (human chorionic gonadotropin). HCG triggers the release of the egg(s).
• IUI (intrauterine insemination).
• Experience shows that these medications sometimes work when Clomid® has failed.

Current medical literature shows that a short number of these treatments, when compared to several others, gives you the best chance of achieving pregnancy and having a baby. However, extending this treatment beyond the recommended timeframe is not more effective. Increasing the number of treatment cycles does not increase the chances of having a baby and only delays the possibility of achieving a pregnancy through the use of other options. In addition, the unlimited use of fertility-enhancing drugs may carry health risks.

For couples in their twenties and early thirties, this therapy is successful approximately 40% of the time with 3 cycles of Clomid® plus IUI and 3 cycles of injectable gonadotropins and IUI. As mentioned earlier, age is an important factor in the success of this therapy. There is limited information about the success of this therapy in women over age 39. However, after age 43 this treatment has not been shown to be effective. Also, the chance of having a miscarriage is estimated to be greater than 50% for infertile women in their forties. Failure to produce an expected number of eggs using a normal dose of medication indicates an egg problem (diminished ovarian reserve). Women with diminished ovarian reserve no longer have unexplained infertility. More medicine—either more cycles or higher doses—do not improve pregnancy rates.

Please refer to the individual instructional sheets addressing Clomiphene Citrate (Clomid®) and gonadotropins.

Two medical options are in vitro fertilization (IVF) and in vitro fertilization with intracytoplasmic sperm injection (IVF / ICSI).

Any treatment related to unexplained infertility needs to be thoroughly discussed with a health care provider.

It should be known, however, that most employers having Kaiser Foundation Health Plan benefits do not provide coverage for IVF and IVF/ICSI for their employees.