37 unexplained infertility... any tips?

[StarryHannah]

Hello everyone
I've spent years going through threads on here looking for answers but this is my first post. My husband and I (he is 34 and I am 37) have been trying to conceive for four years. Neither of us have ever had a pregnancy.

All very recent results from going to private clinic were great- my AMH is above normal, his sperm are strong, scan showed healthy and normal womb etc. Couple of weeks ago had the HSG xray which showed no blockages (it was slightly painful so not sure if linked to my extremely tilted uterus?). We have another appointment with our private doc next month to discuss next steps (given up on NHS completely after years of being fobbed off, within a few months of paying privately we have had all these results).

Anyway we were told by private doc there is increased chances of pregnancy after the HSG and to keep our fingers crossed. We have regular sex, track ovulation, take folic acid and vitamin d daily. Is there anything else you could suggest... even if it's a book to read? We don't smoke and are of healthy weight. Any foods I should eat or avoid? Thank you all so much. If the next couple of months don't end up in natural pregnancy we are going to be recommended to go down ivf route due to unexplained fertility (and my age) even though all results have been outstanding xxx

You could try the book "it starts with an egg" as that has advice on supplements although I didn't find it made much difference to me

Also over 35 I changed my supplements to Proceive Max for Women which has more stuff in it at higher concentrations and is designed for women over 35

Did your partner get a semen analysis too? I'd assume so and it's fine as you said all tests were fine but just want to check.

We are unexplained too. I wish I could give the answers you need :(
Waiting it out on the NHS here though.

Hello :)
Thank you ivfbeenbusy I will look into that. Funnily enough I was taking them (and my husband was taking Male conception ones) but fertility doc told me they were a waste of money and to just get the boots brand vitamin d and folic acid. I might start taking the others again now you say that.

Thank you will it happen ... yeah the words fertility doc used to describe his semen results was 'exceptional' they were that good.

I'm really baffled with everything being great or 'above normal' (my amh is 39 when the top end of normal for my age and thr fertility doc emailed me back saying this was 'very good')

Never mind I'm hoping this magical flush of my tubes will have worked wonders but I'm not getting my hopes up just in case xxx

Sorry that should have read for amh the "top end normal for my age is 37"

Hi Hannah. I’m in a really similar boat- I’m 37 and have been trying for 3 years. All tests have come back clear (I did have endometriosis, but had it removed last year). I read “It starts with the egg” and now I take so many supplements I pretty much rattle in the mornings :) No luck yet, but they’re giving me some hope at least. I’m currently reading “The art of baby making” by Gerad Kite, and although I was a little sceptical at first, I’m enjoying it and it’s made me think differently.

I'm 37 and started trying to conceive when I was 33. I wish I knew about infertility at that time! I wasted two years of my life with the NHS. We were also diagnosed as unexplained infertility, and all tests came back great AMH and semen. At 36 I had my first private IVF cycle and my daughter Maya was born in February. We have had unprotected sex for more than 6 years and I have never been naturally pregnant. Being trying for a sibling and still nothing. If you already been trying for years do not waste more time and go straight to IVF as the eggs quality declines with age. Freeze some eggs for future siblings. Good luck ex
I should have done IVF before...

Hi @StarryHannah
I don't have a happy ending as yet just wanted you to know you are not alone.

I'm 35 hubby 40 married for 5 years. We don't smoke, I cut out coffes, teas alcohol and no sugar. All our food cooked from scratch, no takeaways, organic where we can and tried all supplements possible.
All our results came back great, both hubby's and mine. Had Hycosy twice in the past few years, tubes clear. Had acupuncture for a year and tried Chinese herbs but stopped after two months. Tried Letrozole for 6 months no luck.

'Unexplained' is not a diagnosis, the doctors are just lazy to look deeply into it and do further testing. I was desperately looking for answers over the years and although learned a lot couldn't find an answer.

First I suspected my luteal phase is too short with 9-10 days but in the past so many months it was 12-13 days and still not pregnant so who knows. I also have very short light periods which could indicate lining issues. The Chinese herbs made a slight change but I didn't like the side effects so not taking it any more.

Endometriosis is one of the causes for unexplained infertility and I was shocked to learn that how common is to have it without any symptoms. Unfortunately only laparoscopy can confirm it.

I'm on waiting list for IVF. My advise would be don't get obsessed about it, have a balanced diet and everything in moderation. All my extreme lifestyle changes didn't result in Bfp so why punish yourself. I wish you best of luck X

Unexplained is no diagnosis at all; all this means is that they have failed to find out what is wrong. Sometimes it is a "diagnosis" given to couples when they have not been adequately investigated. Do not ever accept being told that you are unexplained.

Do not worry yourself about your tilted uterus; many women have this issue.

The most common tests that tend to be omitted are:-

Adequate x-rays of the uterus which may show abnormalities not otherwise seen at laparoscopy.

Hysteroscopy - telescope inspection of the inside of the uterus which may occasionally show abnormalities not seen otherwise

Repeated sperm counts over several weeks and months to make sure there is no subtle abnormality

Testing the sperm in special media such as swim up tests and velocity testing. However, when they are done, they often uncover a hidden cause for the supposed unexplained problem

Thorough hormone tests to detect abnormalities of male hormone or early falls in progesterone

Scanning of the ovaries to see if follicles really are developing and there are no sign of polycystic ovaries.

Also have you had day 2 and day 21 tests to see what your hormone levels are like; I ask only as this has not been mentioned by you. You need a diagnosis first and foremost and you will need to be persistent in order to get answers.

I agree

Most of the time "unexplained" is most likely to mean poor quality eggs. But you won't know for sure unless you do IVF with PGS testing (which is flawed in itself)

I PGS tested some embryos aged 36 after 5 miscarriages. At my age I should have got at least 50% come back chromosomally "normal". I didn't get any. All had chromosome issues.

Thank you all for your comments. I know they are all realistic comments but now I'm feeling even more sad about the situation than I originally was.

@AttilaTheMeerkat
Thank you for this ... we've had amh blood tests (no others), semen test, intravaginal scan of womb, ovaries etc and the dye test.

NHS have fobbed me off for years and they agreed to send me to a gynae who eventually agreed there were issues and put me forward for the lap and dye (still waiting for these 2 and half years later hence why I paid for the dye test). Would you recommend I still have the lap even though fertility doctor is convinced i don't have endometriosis from the other tests I've just listed?

It seems I shouldn't have been taking specialist word as gospel xxx

@Chicasimona I really hope you do get your happy ending xxx

I would not have a laparoscopy if they are convinced that endo is not present and besides which you do not want any more surgery than is absolutely necessary.

The day 2 and 21 tests are standard so I am surprised that these have not actually been done. These two tell you about your hormone levels during the cycle. Did they also test your man's samples like described in my previous post?.

Also any test result over 6 months should be discounted; both of you should have and need up to date test results.

@AttilaTheMeerkat

I know that his results were in depth... she spoke about swimming direction and lots of other things. We were a little overwhelmed at the time so I might ask to have results emailed to me just to have a good look and check what you've asked.

His semen results are from about 11 months ago but fertility doc said as so high they won't need redoing ... I'll see about this redoing.

My results have all come since August this year. I had dye test two weeks ago and clinic nurse phoned to go through results and ask if I had thought about icu/ivf yet which shocked me a little. Got online appt with fertility doc next Monday to discuss next steps... maybe she will mention these blood tests then? Xxx

Hi all
Following on from everything turns out I am severely anaemic. Has anyone had this being the reason why they were unable to get pregnant before? If so, what did the doc prescribe you and how long did it take for you to fall pregnant?
Many thanks x

As well as 'it starts with the egg', I've just read 'awakening the seed'; really simple, but helpful in breaking down what you can do to improve chances. I also listen to 'fearlessly fertile' podcast which I find empowering! Focuses on using a positive mindset. I too am 3 years trying now, waiting on nhs, but tried to go private - but they picked up on issues ignored by nhs! So am now back waiting on nhs list for a hysto :( hence why I'm trying to focus on the things I can control - using the above resources!

Hi @StarryHannah - are they looking into why you are severely anaemic? If you have a relatively normal diet then you should not be. I think fibroids can cause anaemia but I imagine they would have been picked up on your scan, if present. Coeliac disease is what immediately springs to mind, since anaemia was my main symptom for that and it is well-known to cause fertility problems when undiagnosed.

@Dinosaurus86 I've been prescribed ferrous sulphate for 3 to 4 months. I've been given no details as got relayed the information from the doctor's receptionist. I know I was tested for thyroid, b12, liver etc. I didnt have coeliac test though. Do you think this is worth getting done because I'll pay private if nhs won't do it. I don't get any bloating or anything but suffer with a lot of gas and trapped wind (not sure if that's relevant?) Xx

Hi and good luck. You could ask whether iron transfusion might be option if you are 'severely' anaemic. The oral will take a while to be absorbed, replace your stores and then for your body to make red cells. The anaemia might be new if you've not been told before but had any other bloods in the last few years. It's on the basic panel.

We were labelled Unexplained after US, the salpingogram, all the bloods, the semen and a laparoscopy. I don't think it's a bad term by itself. I think of it in terms of all the stuff that has been ruled out (anatomy, anovulation, endo etc etc). IVF is also partly diagnostic for fertility because some problems can only be diagnosed under the microscope with the egg and sperm. 'Unexplained' doesn't mean your Dr thinks you should suddenly get pregnant, but that they haven't found anything to tailor treatment too. Your AMH is reassuring for you IVF chances.

Also modern fertility medicine is new and getting more knowledgeable all the time but many couples have every test known and still do not have a specific reason identified. This is not laziness.

I couldn't find any evidence on most of the supplements or accupuncture in med literature so I stuck with a multivitamin, folate, coQ10. Some evidence that accupuncture relieves stress though.

Dinosaurus - great suggestion

@StarryHannah I would definitely try to get a blood test for coeliac. Be careful not to go gluten free before the test because it won’t be accurate. If it’s difficult to access the test and you feel you’re against the clock then you could just go gluten free anyway, but really if it is coeliac you should get to see a consultant at least in the first couple of years - and you have to be extremely strict with the diet for it to work properly. I’ve found care is very variable across different areas.

I would recommend requesting the blood test from your GP ASAP. Unexplained anaemia should be a trigger for it by itself but you can also mention the gas etc as a supporting factor. If they are difficult and you have the money then I would pay to see a private gastroenterologist, at least for an initial consultation and hopefully they would then pass you back to the nhs. I had some of my initial diagnosis privately and then moved back. So I had the blood test on nhs but then the gastroscopy (because my blood test was positive) privately because the waiting list was so long and you can’t go gluten free (and hence resolve the problems) until you’ve had that test.

For what it’s worth, I had a course of iron tablets following diagnosis (after years of being on and off them) and haven’t been iron deficient since (except for after giving blood, which I’ve learnt I simply cannot do). Also, just to add that if you do have coeliac then I believe you should be on the higher dose of folic acid when ttc.

@indub thank you so much for this. Do you mind me asking how things have worked out for you? Are you still unexplained?

@Dinosaurus86 I have spoken to my private fertility doc and she has recommended the same as you. I've emailed my NHS doc to see if they did coeliac test, and if not could they do one. If it becomes a faff or long waiting I'll go private as I just want to get everything done with asap xxx

I read that book 'starts with the egg' by Rebecca Fett. She is really good. I am putting together a series of videos on how to improve your chances of natural conception and up your chances with IVF I have been reading up A LOT. Mostly on professional clinical studies and trials and comparing success rates and I thought they really should be one place to get reliable information. so im creating one lol. Will post them next week. Im bring out all the things from the studies I have been reading about in hopes of finally getting pregnant myself. Will post a link to my videos in a few weeks, just if anyone is interested xxx

@StarryHannah I just thought I’d chime in with my story, my DH and I had been trying for 12 months unsuccessfully when we went to the GP. I was 27 and DH 34. The very first test they did was day 21 bloods and those came back and showed that my hormone levels were fine but I too was severely anaemic.

It took around 4-5 months of iron tablets for my levels to reach the low end of normal (I had repeat tests every month to see how they were doing) and when I reached normal we conceived the very next month.

My periods had been very light for years which I’m sure was related. When I was on the iron tablets they got heavier.

Good luck and I hope addressing the anaemia helps!

Hi

Also please get your day 2 and day 21 tests done. It’s a blood test to check hormone levels. Although I had day 21 only.
This is the first test that should be done. If you’re not ovulating you can’t get pregnant. I wasn’t and needed clomid.

If you’re iron levels are low were you still having regular periods? If it was a severe iron level deficiency you would need an iron transfusion. My sister was low in iron and after the transfusion she became pregnant the next month. She had secondary infertility and was trying for 7 years for the next baby.

Good luck

Hi @DinoGreen , that's great news! Apple fir weighing in; Were the iron tablets prescribed or over the counter? I too have light periods and have be been trying for 3 years, Thanks!