‘Unexplained’ infertility yet our test results are great. Going for IVF but else can I investigate?

[Decaffe]

Briefly, for whatever reason, I can’t get pregnant.

The plusses
My day 3 and 21 bloods are fine.
My HSG was clear and my tubes are ‘perfect.’
My antral follicle count is good for my age.
My womb appears healthy with good blood flow.
By taking ubiquinol I now regularly ovulate on cd12-13
DH’s most recent sperm tests were phenomenal (after I gave him lots of supplements to get his morphology up).

The possible minuses
I have a small dermoid cyst on one ovary but apparently it would cause more damage to take it out.
I am approaching 40.
Although I have a 15 day luteal phase, sometimes I can start spotting from 10dpo.

We are commencing IVF soon but I am convinced that it won’t work. Something is clearly wrong.

I have never had a conversation with an NHS consultant. A nurse simply reviewed the tests then referred us for IVF.

The IVF consultant was lovely but our meeting was, understandably, all about the IVF process and not about what’s wrong with us.

I want someone to tell me what’s wrong and what we can do about it.

There must be something, they simply haven’t found it yet.

Any ideas please?

We have tried the SMEP and the ‘purple’ method.

We have tried DTD twice a daily, daily, every other day and every three days.

We have tried fertility lube and we have tried the cup that holds the semen in.

Hi love, so sorry - infertility sucks! The only thing I'd say is that none of those investigations are focused on egg quality.

So you won't know if the DNA of your eggs or, actually, the DNA in your DH's sperm are ok or not.

You may be making a little embryo every month but there's a DNA issue that each month means it can't develop or implant.

IVF can help because they will develop the blastocysts and can do some genetic testing to see if they're normal. Not a silver bullet as they can't test for everything and the process itself can cause some embryos to get damaged, but it is worth asking about.

Another thing to check would be sperm DNA fragmentation, which is becoming more affordable.

I would definitely push for a chat with your IVF consultant to discuss egg quality and sperm quality more clearly with you. Good luck!

Separately, what supplements did you use to get your DH's morphology up? My husband's sperm is great, other than a 4% morphology score. I've got him on wellman conception which contains l-arginine and selenium and high quality ubiquinol. Any tips?

Have you ever fallen pregnant op?

It sounds similar to my situation. It was only when we went private, third attempt, that the clinic suggested ICSI. For whatever reason, my eggs looked perfect but had an outer layer that wouldn’t let sperm through. When we tried ICSI 16 out of 19 eggs fertilised so we went to blastocyst stage, ended up with eight fertilised, two implanted and the rest frozen.

I was 40 when DD arrived.

Thrombophilia disorders were behind my unexplained infertility. I think! We never found out.

I was in a similar situation and also felt frustrated. I really didn't want ivf. I wanted to know what the problem was so I could fix it! We were good on paper but something just wasn't working.

We ended up going for ivf. I got pregnant from the first round but miscarried. And pregnant again from the fourth round and had a live birth but a premature one. In the successful pregnancy I had a massive bleed in the first tri so my body tried to reject that pregnancy too but it hung on somehow. And then later in pregnancy there was an issue with blood flow through the placenta so she needed to be delivered early. Needless to say, she is an only!

And I never did find out the issue. My placenta was supposed to be sent off for analysis but I never got the results and I didn't chase too hard as I was dealing with a new born and pretty overwhelmed by the whole nicu experience.

Have you looked at your nutrition?

Agree a conversation with the IVF consultant!

There could be so many things OP. After 5 years of investigations and multiple MC , turns out my DH is carrier of a genetic chromosome issue in his sperm. He has plenty of very mobile sperm so his initial sperm tests came back great! The genetic test was a blood test specifically done after recurrent MC.

It's a mine field unfortunately trying to find reasons.

My DSIL tried for 4 years and never even got a positive pregnancy test during that time. Had IVF which resulted in twin babies first round. She never found out the cause of her not catching pregnant naturally.

We had multiple MC before IVF, had several IVF attempts which resulted in MC and we remain childless as the chromosome issue does make viable foetuses.

Have you had an antiphospholipid blood test?

Not to go into too much detail the women I know who were similar had issues with -

• vitamin D levels


• thyroid hormones

Check all these are optimal not just ok. Can be done independently using private blood tests. The companies who do them e.g. Medichecks, Blue Horizon, labs also do NHS blood tests as well.

However make sure you:

1. Stop any vitamin/mineral supplementation for 2 weeks before the test


2. Take the blood tests first thing in the morning before eating and fasting 12 hours for the truest thyroid hormone results.

With the thyroid hormone as the woman was in "range" but the low side it was only because she had unsuccessful private IVF cycles then told to take levothyroxine before having another cycle, which ended up being on the NHS and successful. The NHS consultant thought the idea was rubbish but went along with the private consultant. Then the next private cycle while on levothyroxine was also successful.

Watching this thread with interest OP, because I'm in the same position. I actually had a pre IVF referral appointment at my hospital today to check follicles etc, and I asked the doctor about this. She said it's probably a combination of egg quality and fluctuating sperm quality - my partner's had two sperm tests, one of which was normal and one of which showed a significant proportion of positive antibodies.

Very interested in ICSI, but the NHS doesn't offer that where I am. So I'll take the first free round of IVF and then if that doesn't work, talk to the clinic about ICSI.

Best of luck to you.

Coming close to 40 I would imagine it's egg quality due to age.

Do you have hay fever, allergies, any autoimmune conditions?

I also had ‘unexplained’ infertility despite really good egg numbers

it only worked when we saw a consultant who specialises in immune stuff. He spotted straight away that my allergies, hay fever and autoimmune thyroid thing, plus that I never got colds, showed my immune system was not functioning properly and probably killing off embryos

2 months of immune suppression and I was pregnant…

Hi, I am sorry you are going through this. I can't help with personal experience, but from what I know, unfortunately, unexplained is one of the most difficult to treat, even via IVF. What I recommend is to ask your clinic a) how experienced they are in unexplained b) what results they get in unexplained treatment considreing your age c) how long the treatment might take and how much it will cost. In some cases, IVF PGS NGS is more effective than IVF, in some cases docs might offer other solutions. But fertility specialists who will be treating you should have experience in that field. Hope this helps.

@sparechange yes I have allergies to all sorts of things, cats/dogs, hay fever, dust mites, some skin care ingredients, latex..!

@RedWingBoots I have been low in Vit D before but take a high dose supplement. My last thyroid test was a year ago; my free T4 level was 16.1 with a reference range of 9-22, and TSH was 0.44 with a reference range of 0.1-4.

@RudsyFarmer I believe I have had a ‘chemical’ pregnancy although I didn’t realise at the time that’s what it was. I got the faintest of lines on a FRER, then my period arrived early and was exceptionally heavy and with clots. My nipples also leaked something that looked like olive oil, which was bizarre!

Lots here for me to take in and mull over, thank you.

Thank you, as well, for the kind words. It is helpful

Given your allergies, I would really really encourage you to see one of the specialist fertility immunology specialists

where abouts are you based?

Have you ever had a successful pregnancy/baby?

If not I'd say it's simply your age. Your eggs are just not as healthy as they need to be for natural conception

Same here op.

Started TTC when I was 25.
Had IVF at 30

Both DH and my tests were all perfect.
Thankfully our first round of IVF was successful and we had DD.

We haven't used any form of contraception in 13 years and never had even a sniff of a natural pregnancy. Which just seems mad to me considering all tests were fine!

Would love to know why but I doubt we ever will x

If you're going for IVF I'd do the PGT-A testing to give yourself the best shot if you can afford it, based on the age. I had recurrent miscarriages at 32 and 33 so we did PGT-A for my recent IVF cycle at the start of 34 and only 25% were normal. We've tried with one of the normal ones and it's led to a miscarriage unfortunately but the idea of doing IVF just to transfer one of the randomly abnormal ones and be guaranteed a miscarriage was too much for me to contemplate after the expense and pain of IVF.

My consultant used to say that if you can fall pregnant there’s a good chance you can have a baby. It’s the falling pregnant that can be the issue.

ivf does sound like a good plan as if it’s egg quality they can weed out the embryos that have chromosome issues. If it’s a problem with your body rejecting the pregnancies there are drugs you can take to counteract that.

How long have you been TTC? We were diagnosed with unexplained infertility and were about to start IVF when I conceived my son naturally, it was 2 years from when we started trying. I've since had 2 more natural pregnancies without really trying (1 mc, 1 current) which I just find bizarre!

I’ve stopped counting now, but over 18 months @LittleLottle

We were the same as you. Did ivf as the consultants said that doing the ivf process would be the best way to answer the questions. We did one round which resulted in tonnes of blastocysts. First transfer failed but the second transfer resulted in my son. We very easily conceived my second child the old fashion way the very first time we tried. We will never know what was wrong with us when we first started trying to conceive but the consultant did say to us that unexplained infertility is the best kind of infertility.

Hi there OP was wondering if you had any luck and found out any more detail about what the problem was? My story is very similar to yours and still haven’t found a cause.