Despite present-day science and techniques, it is not always possible to find an apparent reason for reduced fertility. “Unexplained subfertility” means that the conventional series of fertility tests on both partners has not led to the cause of the infertility being identified. This diagnosis is made in approximately 10 % of couples with reduced fertility. Another term that is often used is unclear reason for subfertility.

On the one hand, it is comforting that no defects have been found. On the other hand, you are still not pregnant and have no explanation about the possible reason. However, whether or not a pregnancy occurs can be a question of luck and one couple may need more time for a spontaneous pregnancy than another. There is, however, no certainty that a spontaneous pregnancy will finally occur so, in the end, couples may have to resort to treatments that promote fertility. When this moment is reached will depend, among other things, on the age of the woman and the length of time she has wanted a child. Until that time, you will have to adopt a wait-and-see policy.

The emotional problems experienced following a diagnosis of unexplained subfertility are difficult and frustrating, especially as you no doubt began the tests with the expectation that a diagnosis would be made and solution offered. Naturally, some couples have the overwhelming desire to continue looking for answers, but they comes a point at which it is important to accept the diagnosis of unexplained subfertility.

Individual doctors differ in opinion about what they consider to be a conventional series of fertility tests. Besides assessing the previous medical history and a physical examination, the following are generally included.

For women:

• Hormone level tests
• Ovulation function test
• Post-coitus test
• Trans-vaginal ultrasonogram
• Hysterosalpingogram (HSG) (x-ray image of the uterus and Fallopian tubes with the aid of a radio-opaque dye)
• Laparoscopy (in which a thin telescope is inserted into the abdomen to study the uterus, ovaries and Fallopian tubes)
  

For men:

• Semen analysis
• Hormone level tests
• Sometimes additional tests on sperm motility, penetration, antibody diseases, blockages or infections

Just as the tests used to diagnose unexplained subfertility differ from doctor to doctor, the same is true of the treatments offered for this diagnosis. However, the following treatments are often used:

• Ovulation-stimulating drugs often beginning with Clomiphene citrate, possibly followed by gonadotrophins.
• Intra-uterine insemination: (artificial insemination of sperm into the uterus).
• In-vitro fertilisation: (IVF) (ova and sperm are combined in a laboratory, after which the fertilised eggs are placed in the womb).