The Myth Of "Unexplained Infertility"

In this era of modern Reproductive Medicine, infertility in virtually any couple can indeed be explained. The concept of "unexplained" infertility is simply relegated to bygone days. The primary key is expeditious, effective, efficient evaluation of the couple----male and female factors. In such a simple process, one can quickly discover the issues with minimal inconvenience to the couple and move forward with a plan of action. There is no need for a painful, excessive battery of expensive, exotic tests that are often done 'routinely' without reflecting specifically on the specific couple's situation. A focused, yet thorough, assessment based upon the couple's issues, determined through a consultation with Dr. Peter Ahlering, in person or on the phone, or video teleconference is the initial step to getting answers fast. Then, of course, rapid follow-up discussion can outline all available medical options for a treatment plan of action that suits the couple. Ultimately they, the patient(s), decide on what fits their interests, budget, personal situation and timeline. There are always options that are present for any case so they just need to be identified and discussed satisfactorily, patients just need to know.

Embryologist adding sperm to eggs in laboratory

Embryologist adding sperm to eggs in laboratory

One often overlooked issue in many couples is proper assessment of the male factor. The old school thinking overemphasizes sperm count and motility; as if there have been no technological advances in the last 20 years for assessing semen qualitative factors that are key for proper embryo growth and development after fertilization. Minor alterations in sperm quality, a reflection of genetic integrity, can have a drastic affect on a couples reproductive potential. Also, very often sperm qualitative issues are seen in males that have a 'normal' basic semen analysis…everything is 'good' the couple is told. Looking at easy tests such as DNA fragmentation in sperm can be revealing…all from a singlesample. While DNAF is key, there are other more recent developments in semen assessment that have proven very useful as well. It is not necessary to waste precious time and finances performing a multitude of blood tests and other procedures that completely overlook the proper assessment of the components that make a baby—sperm and egg.

Don't misunderstand, however; while uterine factors can infrequently be a significant problem thwarting a successful pregnancy, it is very rare indeed. Distorted uterine anatomy, for example, is easily diagnosed. With proper ultrasound (not a hysterosalpingogram or HSG). I am often asked, could there be some obscure uterine problem that affects early pregnancy, leading to very early implantation failure? Could there be even imperceptible implantation failure, before the female notices with a positive pregnancy test? While the answer is 'yes' it is possible , it is terribly rare indeed and, in fact, is highly implausible! Again, such diagnoses are on the list to be considered but they need not be performed on every couple that comes in the door, start at the top of the list of important factors!

Assessing a patient's risk factors for such unusual uterine implantation problems is easily done with a consult in which risks are identified in the vast majority of cases, without need for a slew of esoteric lab tests. Doing the right tests in the right people, sounds easy but often a rule not adhered to. This sort of implantation problem is a diagnosis of exclusion, however; after the much more common and fundamental issues have been assessed like egg and sperm problems. If these critical tests do not provide the proper answers to fit the case, then one must look further of course. However, it still does not take long to keep moving to reach the answers and formulate a plan—without breaking the bank.

woman getting an ultrasoundAn all too common problem occurs by glossing over the proper assessment of the vital elements that affect early embryo growth and development. Proceeding with a 'one size fits all', 'cookbook' infertility evaluation or allowing premature assumptions to dictate medical management from the beginning often takes a couple down a misleading path of further unnecessary tests and excessive treatments.

So arrange for a consult with Dr. Peter Ahlering and get on the right path, right now! MCRM will provide you with real savings by maximizing your valuable time, minimizing your frustration and sparing your emotions---this can be impossible to calculate. It is worth a talk.

If the treatment of choice is an advanced procedure such as IVF, or any other reproductive technology, this too can be done at significantly lower cost but not by compromising results.