Idiopathic infertility — when all tests are “normal”

Imagine: you go through all the research. Hormones are okay. The pipes are passable. Spermogram is normal. Ultrasound is normal. And yet... there is no pregnancy. Then there is often a diagnosis that sounds almost like a question: “Idiopathic infertility.” Or in other words, unexplained sterility.

What does “idiopathic” mean?

“Idiopathic” means that no specific cause has been found for the difficulty conceiving, although all standard tests appear to be normal. However, this does not mean that the cause does not exist. It only means that at this stage, medicine has not caught it through the available tests.

How often does it occur?

Idiopathic infertility occurs in 10— 30% of couples who sought help in an in vitro clinic. It is not the “rare case”, but a well-known scenario that we work with on a daily basis.

What can be the hidden causes?

- Subtle disturbances in ovulation or ovarian reserve;
- Unexpected immunological or inflammatory processes;
- Defects in the quality of the egg or sperm;
- Disorders in the receptivity of the endometrium;
- Microbiome or autoimmune factors;
- Subclinical hormonal imbalances.

What follows after such a diagnosis?

1. Repeated, more thorough diagnostics, which may include:

• Sperm DNA fragmentation test;
• HBO test for functional maturity of spermatozoa;
• CatSper test — a specialized laboratory analysis that examines the functionality of CatSper channels in sperm;
• ERA/endometrio tests;
• Immunological and thrombophilic panels;
• Genetic screening and karyotype;
• Hysteroscopy.

2. A personalized action plan

Most often it is recommended:

• Controlled ovulation and follow-up;
• Insemination (IUI);
• In vitro with an individual protocol;
• Freeze-all strategy;
• Genetic testing of embryos (PGT).

The psychological aspect

The diagnosis can be particularly frustrating — how do you deal with something you don't understand? But you're not alone. The fact that the cause is not visible does not make it insurmountable. Modern reproductive medicine has a multitude of means at its disposal, even when there is no clear culprit.

What is important to know?

- Idiopathic infertility is not a sentence;
- Not an exception — many couples have gone through it successfully;
- It does not mean that you have to wait “for it to happen only”;
- Even “normal” research sometimes does not tell the whole story.

Conclusion

When the diagnosis is “unclear”, the path may seem more unclear. But that's when experience, attention to detail, and modern science come into play.
At our clinic, we believe that even behind the quietest cases lies a solution. It's just that sometimes it wants a little more demand — and a lot more support.

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