Navigating the Challenges of Unexplained Infertility
Unexplained infertility is diagnosed when standard fertility tests for both partners are normal, yet pregnancy does not occur. Performing endometrial receptivity tests, such as testing for BCL6, can determine whether underlying conditions are interfering with conception. Here are a few tips for navigating the challenges of unexplained fertility:
Understand Diagnostic Approaches
A comprehensive evaluation process involves diagnostic techniques, such as sperm quality evaluations and genetic testing. Women may undergo blood tests to assess hormone levels and measure ovarian reserves. Doctors might also suggest getting a uterine assessment to gauge any underlying structural problems. These evaluations assist doctors in assessing unexplained infertility.
If endometriosis is suspected based on clinical findings or imaging, this may lead a clinician to try additional molecular testing; such testing includes an assessment of BCL6 expression to further evaluate the possibility of underlying disease. BCL6 is a gene involved in inflammatory signaling pathways, and increased expression of its associated protein in the endometrium has been correlated in some studies with endometriosis. Detection of elevated expression does not confirm a diagnosis on its own, but it may support further evaluation or inform clinical decision-making. Additional testing is performed to identify the presence of the related protein; this provides insight into endometrial conditions that may be associated with impaired implantation.
In other individuals, implantation challenges are associated with chronic endometritis, a condition characterized by persistent inflammation of the endometrial lining. Immunohistochemical testing for the CD138 marker is used to identify plasma cells consistent with this condition. When detected, these findings help guide targeted management strategies aimed at addressing inflammation. Test results are used as part of a broader clinical assessment to help physicians tailor individualized treatment approaches.
Evaluate Treatment Options
Some underlying issues, such as sperm quality problems, remain undetected during standard infertility evaluations. A doctor reviews the diagnosis with you and your partner and discusses available options. Time-lapse embryo monitoring tracks cell division patterns throughout early development and helps identify embryos with atypical growth dynamics. This technology supports IVF decision-making even when routine testing shows normal results. Other evaluations include testing for anti-sperm antibodies, uterine structural abnormalities, and problems related to uterine receptivity.
After the doctor rules out structural, hormonal, and genetic abnormalities, couples shift their focus toward treatment strategies. Younger women often pursue hormone therapy combined with intrauterine insemination, while older women or couples with prolonged infertility typically move toward more advanced treatments. Intracytoplasmic sperm injection (ICSI) addresses fertilization challenges associated with low sperm counts or function despite normal findings on standard fertility testing. This approach improves fertilization efficiency and supports progression toward pregnancy within assisted reproductive treatment cycles.
Seek a Fertility Specialist
When natural fertility optimization does not lead to pregnancy, a fertility specialist often reassesses the diagnosis and looks beyond standard findings. This review focuses on subtle factors, such as how uterine receptors influence embryo implantation, and it helps uncover details that support more precise treatment planning. When testing confirms endometrial inflammation associated with elevated BCL6 expression, a specialist may initiate anti-inflammatory therapy before hormonal treatment or assisted reproduction. In some cases, intralipid infusions form part of an immune-modulating strategy aimed at reducing systemic inflammation. By expanding the diagnostic panel, BCL6 testing provides additional context that helps clinicians address underlying contributors to infertility that standard evaluations do not capture.
Assess Genetic and Hormonal Factors
Genetic analysis offers another pathway for investigating persistent infertility by examining mutations linked to impaired gamete function. Variants in genes involved in sperm DNA repair are associated with reduced sperm quality, and these abnormalities are linked to difficulties with fertilization or early embryo development. In women, certain X chromosome variations and chromosomal translocations correlate with disrupted reproductive function and irregular cycles, which complicate conception. When clinicians integrate genetic findings with hormonal assessments, they gain additional context for selecting stimulation approaches. Individualized medication protocols and procedures then align treatment strategies with identified genetic and endocrine factors to support more precise ovarian stimulation planning.
Schedule a Consultation for Unexplained Infertility
Clinicians will review a patient’s medical history, perform tests, and create a personalized treatment plan. The diagnosis of infertility involves performing tests to validate the presence of endometriosis; other diagnostic tests may include genetic testing and imaging. After confirming the presence of endometriosis, your clinician will recommend medical therapies or surgical treatments. Take the first step toward managing unexplained infertility by scheduling a consultation with a fertility specialist.
