How to deal with the diagnosis of sterility due to unknown causes

Now what? Why can’t I get pregnant?

These are undoubtedly the first two questions that come to mind after being evaluated for a fertility problem and the doctor tells you that there’s no known cause that explains why you can’t get pregnant.

Nowadays, basic sterility studies are unable to detect the exact cause of over 25% of all cases, which doesn’t mean that it can’t be diagnosed with specific tests or that a case with an unknown cause can’t be properly treated.

This high percentage, which sometimes reaches 40%, can be explained by the fact that there are many complications in carrying a pregnancy and a basic study doesn’t analyse them all.

Although the exact causes are unknown, if we can begin treatment:

Possible treatments

It is important for the couple to improve their reproductive health and create a favourable environment for conception by eliminating toxic substances such as tobacco and illegal drugs that affect the quality of reproductive cells, being aware of the most fertile days of the cycle, including antioxidants and certain vitamins in the diet, correcting unbalances in body weight and finally, improving and adjusting their sexual technique. For example, about 10% of women have a retroverted uterus, which reduces the chances of the semen easily reaching the uterus. A simple solution that can improve this situation is to have intercourse in positions that guide the penis into the uterine axis.

The doctor can treat slight ovarian dysfunction, which often cannot be diagnosed through simple treatments.

In vitro fertilization as a diagnosis and treatment tool

In many cases the diagnosis and treatment come together. Thus, In Vitro Fertilisation allows us for the first time to see the quality of the eggs (female reproductive cells), since we don’t know anything about them until they are collected from the ovaries. We also study the interrelationship with sperm. If fertilisation takes place naturally or there is a failure due to abnormal egg/sperm interaction (which is often called “incompatibility” and successfully treated through IVF). Lastly, we can also learn about the key player: the embryo, since the cause of the problem often does not lie in either the man or the woman, but rather in the embryo.

Therefore, in vitro fertilisation has two advantages: primarily, reaching the ultimate goal: pregnancy, and secondly to answer the two first questions that started off this article: Now what? and Why can’t I get pregnant?

Dr. Rafael Bernabeu, director médico del Instituto Bernabeu

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