Evaluation of women with unexplained infertility

The diagnosis of unexplained infertility should not be made without diagnostic laparoscopy until sub-optimal ovulation, inadequate endometrial development, cervical factor, and medical disorders such as hypo or hyper thyroidism and insulin resistance of Type II diabetes have been eliminated as causes. Studies that report more than 10 % of infertility as unexplained omit one or more of these tests. When these potentially correctable factors have been ruled out there will remain a small percent of couples whose infertility can be explained when in vitro fertilization (IVF) is performed. The findings in these cases are often either oocytes of poor quality, or failure of fertilization and embryos that cease to develop or fail to implant. Results of preimplantation genetic screening (PGS), in IVF cycles performed for age and unexplained infertility, suggest that many cases of infertility are due to aged or defective gametes. However, proceeding directly to ovulation induction (OI) and IVF without diagnosing and treating an underlying medical cause may impair the patient’s future health and fetal development.