What is infertility? Infertility is defined as inability to conceive after 1 year of regular unprotected intercourse. It is 6 months with women older than 35 years. If you were told that you had unexplained infertility, what does that mean? If you have difficulty to conceive for some time, you would be put on some tests to evaluate the underlying causes for the infertility. There is some standard infertility evaluation. It includes a semen analysis, assessment of ovulation, and a hysterosalpingogram (to detect uterine and fallopian tube pathology); ovarian reserve and laparoscopy are further tests that could be done to examine function of reproductive system. When these results are normal, you would be diagnosed unexplained infertility which means that there are no underlying causes for your infertility found. Are there many people suffer from this condition? Yes. 1 in 6 couples are seeking specialist help in trying for a baby. There are about 30% of infertility is unexplained which means the causes for the infertility are unknown. This diagnosis will be based on a series of fertility tests without revealing any abnormality. The frustrating thing is that there is no reason for the infertility, how can you improve the fertility? Change life style? Many people have already had a very healthy life style, good nutritious diet. They do exercises regularly. General health is good. Nothing on this aspect needs to be improved. What causes their reproductive system problems?
Research showed that subclinical pelvic inflammatory disease (PID) is very common in women. Women with undetected subclinical PID have no symptoms, but the pathological mechanisms are similar to those of acute PID. Wiesenfeld et al studied whether women with subclinical PID are at an increased risk for infertility. They found that women with subclinical diagnosed at enrolment had a 40% reduced incidence of pregnancy compared with women without PID. Undetected subclinical PID could be one of the unfound causes for infertility. Subclinical conditions do not cause symptoms but they make reproductive system not functioning properly causing infertility. Embryos are so delicate and they cannot survive in any unfavourable environment.
Genetic reasons, there are many inflammation events going on in women’s reproductive system. Women’s body has an ability to clear this inflammation very quickly, but some women have difficulty to clear the inflammation in their reproductive system. This may affect their ovarian function including egg quality and poor microenvironment. As a result, they present difficult to get pregnant.
Stress, having been trying to conceive for a long time without success makes those couples stressed. Furthermore they are told that the reasons for the difficulty of conceiving are not clear and the diagnosis of the infertility is unexplained. This makes them more stressed. At least some unexplained infertility is caused by stress and all of this stress mentally and physically also makes the condition worse. Stress makes hormone unbalanced and this affects egg development in female and sperm development in male resulting poor quality of eggs and sperms. This makes low fertilization rate and low quality of embryo.
Do you need to be treated to get pregnant, if you were diagnosed unexplained infertility? Is there a chance to get pregnant on your own without any treatment? What treatments are available for unexplained infertility? Yes, you do need treatment. Many studies showed that the pregnant rate was 1.3 to 4.1% in the untreated group with unexplained infertility. This was lower than most treatment intervention. You have more chances to get pregnant with less than two years duration of unexplained infertility and fewer chances when the duration of infertility exceeds three years and greater than 35 years of age. The duration of infertility is important. The longer the infertility, the less likely the couple is to conceive on their own. With infertility 1 year duration, the couple have 20% chances to get pregnant after a year on their own. After 5 year infertility, the chances dropped to less than 10% without any treatments.
What treatments are available for couples with unexplained infertility? There are some treatment approaches available for unexplained infertility, but they are empiric. The standard protocol is to start from low technology to high technology treatment options. There is no evidence showing that any one treatment is better than the other. The treatment of unexplained infertility is dependent on availability of resources and patients’ age and duration of infertility.
Here are some treatment options:
Controlled ovarian hyperstimulation (COH) and Intrauterine insemination (IUI): To maximize the chance of fertilization, COH and IUI have been used. COH involves medications stimulating the development of multiple eggs of the ovaries in one single cycle, resulting in multiple ovulations. Both clomiphene citrate and gonadotropins have been used for COH. This expects more eggs available for fertilisation. IUI involves placement of washed sperms into uterine cavity around the time of ovulation. IUI may increase the density of motile sperm available to ovulated eggs. There has been a marked increase in the use of COH with or without IUI in the treatment of unexplained infertility over the past decades.
In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI): IVF is most expensive, but also most successful treatment of unexplained infertility; it could be done with or without ICSI. IVF involves stimulating multiple eggs to develop; egg collection to get eggs; fertilising the eggs in the laboratory; and embryo transfer to the uterus. ICSI involves picking up individual sperm and injecting the sperm into the cytoplasm (the inner part) of the egg. The same procedure as IVF in women is also involved.
About ten years ago Guzick DS et al from University of Rochester New York analysed the efficacy of alternative treatments for unexplained infertility from 45 published reports. They found that combined pregnancy rates per initiated cycle were IUI 3.8%, clomiphene citrate (CC) 5.6%, CC + IUI 8.3%, gonadotropins (hCG) 7.7%, hCG + IUI 17.1%, IVF 20.7%. More recently research also showed that IVF is more effective technique for unexplained infertility treatment.
Is acupuncture effective for unexplained infertility? Yes, acupuncture is effective and it is one option for couples with unexplained infertility. Acupuncture is playing an important role in infertility treatment. The treatment for infertility with acupuncture increased fivefold in 10 years time. Currently there are many researches show that acupuncture stimulates brain to improve hormone balance. Acupuncture is well known to produce endorphins in brain releasing pain and also affect the levels of pituitary and ovarian hormones which regulate ovulation. Acupuncture stimulates nerve ending, as a result it improves reproductive system blood flow. Subsequently egg quality and ovulation are improved, fallopian tube spam is released, intrauterine environment is more suitable for embryo implantation and growth. Acupuncture regulates immune function to benefit fertilized eggs survival. Acupuncture also increases in sperm count and improves sperm quality in men suffering from infertility. Acupuncture can help reduce stress both in women and men. After a few month acupuncture treatment, women have better quality of eggs and men have better quality of sperms. Better fertilization and good quality of embryos will be obtained.
Acupuncture is also a useful tool for IVF support to increase IVF success rate because of high quality of eggs and sperms. Acupuncture increases two fold of the pregnancy rate of IVF, if acupuncture is performed during IVF treatment. A study has shown that when combining IUI with acupuncture treatments, 65.5 per cent of the test group pregnancy rate was achieved, compared with 39.4 per cent of the control group, who received no acupuncture therapy. These are major benefits of acupuncture
Here are some case studies showing the effectiveness of acupuncture for unexplained infertility.
There is a report in Chinese for effectiveness of acupuncture on unexplained infertility. 58 patients with unexplained infertility were included in acupuncture group. The age was from 26-38 and trying to conceive from 2-5 years. 41 patients had primary infertility and 17 patients had secondary infertility. All patients had normal fertility evaluation. After 3-5 period cycles of acupuncture treatment, 42 patients achieved pregnancy. Following is a typical case. A 26 year old woman was trying to conceive for 4 year without success. Her period was normal but she had a severe period pain. All fertility tests were normal and the diagnosis was unexplained infertility. After 4 month acupuncture treatment, she was pregnant and gave birth to a lovely girl.
There was a study using acupuncture to treat explained infertility.104 women with unexplained infertility were involved in this study. The age of participants was from 26 to 41 and the average age was 32. The length of history of infertility was from 20.8 to 50.3 weeks with average 33.5 weeks. 41 participants (39.4%) had undergone an assisted reproductive technology (ART) treatment before joining the study. The average number of the ART treatments was 1.4 cycles. Acupuncture were offered for 6 month. At the end of the study, 60% of the patients achieved pregnancy.
References
Wiesenfeld H et al Obstet Gynecol (2012) 120:37-43
Ray A et al Reprod Biomed Online (2012) 24:591-602
Hopton AK et al Acupuncture in practice: mapping the providers, the patients and the settings in a national cross-sectional survey. BMJ Open. (2012)11:2-9
Yu Ng et al Fertility and Sterility 2008, 90: 1-13
Gnoth C et al Hum Reprod (2005) 20:1144-7
Guzick DS et al Fertil Steril (1998) 70:207-13
Pandian Z et al Cochrane Database Syst Rev (2012) 4:CD003357
Park JJ et al J Altern Complement Med (2010) 16:193-8
