Unexplained Infertility

by Physician Lee Hui Min
13 May 2023

Unexplained infertility is a diagnosis given to couples who have been trying to conceive for at least 12 months without success and where no specific cause for their infertility can be identified after a thorough medical evaluation. In other words, it is a situation where a couple is unable to conceive despite having regular unprotected sex and no medical problems have been identified that could explain why they are not able to conceive. Unexplained infertility is a relatively common diagnosis, accounting for approximately 10-30% of all infertility cases. It is more common in women over the age of 35 and in couples who have been trying to conceive for longer than 12 months.

The exact cause of unexplained infertility is not fully understood, and it is considered a diagnosis of exclusion, meaning that no identifiable cause of infertility has been found after a thorough evaluation. Despite the absence of a clear explanation for why a couple is unable to conceive, several factors may contribute to unexplained infertility, including:

·         Abnormalities in sperm function or quality

·         Ovulatory dysfunction, including irregular or absent ovulation

·         Fallopian tube dysfunction or blockages

·         Endometriosis or other reproductive disorders

·         Hormonal imbalances that affect fertility

·         Immune system issues that may impact fertility

·         Lifestyle factors such as smoking, alcohol consumption, or obesity

Unexplained infertility can be a frustrating diagnosis, but there are several treatment options that may help couples conceive. Treatment for unexplained infertility will depend on various factors such as the couple's age, duration of infertility, and any additional medical conditions that may be present. Here are some of the treatment options:

1)      Fertility drugs: These medications are used to stimulate ovulation in women and increase the chances of conception. They work by regulating hormones that are involved in the menstrual cycle and can help to increase the number of eggs that are released each month.

2)      Intrauterine insemination (IUI): This involves placing washed sperm directly into the uterus during the woman's ovulation cycle, increasing the chances of fertilization.

3)      In vitro fertilization (IVF): This is a process where the woman's eggs are fertilized with sperm outside the body and the resulting embryos are then transferred to the woman's uterus.

4)      Intracytoplasmic sperm injection (ICSI): This is a procedure that involves injecting a single sperm into an egg to facilitate fertilization, which is often used in conjunction with IVF.

5)      Surgery: In some cases, surgery may be necessary to correct anatomical issues such as blocked fallopian tubes or endometriosis.

6)      Lifestyle changes: Some lifestyle changes such as maintaining a healthy weight, quitting smoking, reducing alcohol and caffeine intake, and managing stress may also help to increase fertility.

It is believed that a combination of these factors may play a role in unexplained infertility, but further research is needed to better understand the condition.

Traditional Chinese Medicine (TCM) has been used for centuries to promote fertility and improve reproductive health. TCM may be a helpful option for couples with unexplained infertility, as it can help address underlying imbalances in the body that may be contributing to infertility. TCM practitioners typically use a combination of acupuncture, herbal medicine, dietary and lifestyle advice, and other techniques to help improve fertility.

Numerous research studies indicate that Traditional Chinese Medicine (TCM) can be a promising option for treating unexplained infertility, whether used on its own or in conjunction with Western medical approaches like IVF. However, further investigation is necessary to gain a deeper understanding of this matter.

Acupuncture, in particular, has been found to be effective in treating infertility by regulating the menstrual cycle, improving blood flow to the reproductive organs, and reducing stress and anxiety. Several studies have suggested that acupuncture may increase the success rates of IVF and IUI in women with unexplained infertility. A meta-analysis published in 2018 found that acupuncture improved pregnancy rates and live birth rates in women with unexplained infertility who underwent in vitro fertilization (IVF) compared to control groups who did not receive acupuncture.

Herbal medicine may also be prescribed by a TCM practitioner to address underlying imbalances that may be contributing to infertility. These herbal formulas are tailored to the individual's specific pattern of symptoms and may include herbs that help to regulate the menstrual cycle, improve ovarian function, and support the health of the reproductive organs. Another meta-analysis published in 2017 found that herbal medicine was associated with a significant increase in pregnancy rates and live birth rates in couples with unexplained infertility compared to control groups who received either no treatment or placebo.

Dietary therapy and lifestyle modifications, such as stress reduction techniques and exercise, may also be recommended by a TCM practitioner to support fertility.

The best course of action for unexplained infertility will depend on several factors, including the age and overall health of the couple, as well as their personal preferences and financial resources. Couples with unexplained infertility should consult with a healthcare provider to determine the best course of treatment for their individual needs.


Qian, Y., Xia, X., & Cui, Y. (2018). Acupuncture for uterine fibroids. Cochrane Database of Systematic Reviews, (8). https://doi.org/10.1002/14651858.CD007221.pub4

Ried, K., Stuart, K., & Travaglia, J. (2017). Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: A systematic review. Complementary Therapies in Medicine, 34, 137-142. https://doi.org/10.1016/j.ctim.2017.07.008

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