EXPLAINING UNEXPLAINED INFERTILITY
Professor Luciano Nardo
“Explaining unexplained”
This is a common query from the people I speak to for the podcast and once again I’m keen to address it. You’ll know I’ve been sharing the content from my new ‘Talk Fertility’ show I’m hosting with Kate Davies. Meet Professor Luciano Nardo Clinical Director at the Reproductive Health Group as Kate and I had a great conversation with him discussing this widely used term.
Professor Nardo explains what really is the frustrating diagnosis of unexplained infertility, why unexplained infertility is never really unexplained and how emotional factors play a part in infertility.
He spoke about how the term unexplained infertility is when no cause of sub-fertility is found. This diagnosis can only be given when basic investigations such as semen analysis and a ultrasound scan are completed and no problem is found.
Professor Nardo believes that currently we don’t have all the diagnostic tools available to diagnose all fertility problems but advances in technology does mean that he sees less patients with unexplained fertility in 2019 than 10-15 years ago, as more causes of sub-fertility are now able to be diagnosed.
Examples of technology now used to identify sub-fertility that we did not have previously – DNA Fragmentation testing
1:4 couples with unknown sub-fertility factors will conceive naturally.
50% of couples will conceive by means of IVF. Not all couples with sub fertility will need IVF but specific issues with egg and sperm can be overcome with IVF. Professor Nardo has found that many cases of unexplained infertility are associated with genetic abnormalities from either partner. His clinic is currently setting up a dedicated clinic to assess male infertility issues as a stand alone service as remote access initially.
Patients are now more informed when visiting a fertility specialist but Professor Nardo feels it is important to fully investigate before embarking on IVF. He does not recommend ovulation induction such as clomid for women with unexplained infertility and feels that this does not shorten the time to pregnancy in these women.
Emotional factors
Impact on ability to conceive and recommends fertility counselling and fertility coaching for support. Professor Nardo recommends counselling when a patient has experienced a failed IVF cycle but feels that coaching is very important at the start of an IVF cycle. We talked about how he believes that we are very quick to label couples with unexplained infertility and even quicker to recommend IVF and that we should put more emphasis on supporting women to achieve natural conception.
Also discussed was how there needs to be more information needs to be made available for same sex couples and also for the health professionals caring for them, we talked about IVF Add ons, experimental procedures that may or may not be beneficial and Professor Nardo talking about how evidence is limited but as long as safe and no consequences then these should be offered.
I referred to a previous podcast episode where I had also spoken about unexplained infertility – which was a conversation I had with Dr Jane Steward and you can listen to that interview here
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Source: The Fertility Podcast
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