If you’ve gotten a diagnosis of unexplained infertility, it’s natural to feel upset, disappointed, and confused. What does that mean today, what are the next steps, and what does it mean for your ability to get pregnant in the future? Let’s dive in.

What “unexplained infertility” means

“Unexplained infertility” is what a clinic writes down when the results of a standard workup come back normal, but pregnancy still isn’t happening. When we say a “standard workup,” that includes a semen analysis, ovulation confirmation, ultrasound, blood tests, and other diagnostic tests that help a doctor understand your unique case.

Roughly 15-30% of infertility cases are classified as “unexplained” after reviewing these initial diagnostic tests. That’s a lot of people without answers!

What "unexplained infertility" often turns out to be

Most of the time, "unexplained" means there’s more testing needed beyond the standard panel. 

In one study, doctors performed laparoscopies (a safe but fairly invasive procedure where a camera is inserted into the uterus or pelvic cavity to identify abnormalities) on women with unexplained infertility diagnoses. 98.6% of tissue samples had abnormalities of some kind, and 90.7% showed signs of endometriosis. Laparoscopy is the gold standard of testing right now, because commercially available blood tests aren’t widely available yet. According to Yale School of Medicine, getting an endometriosis diagnosis usually takes between 8–10 years for adult women. That’s a long time when you’re trying to conceive!

A few other common causes of otherwise unexplained infertility: 

• Sperm DNA fragmentation, which a standard semen analysis doesn't measure

• Low egg quality, which can be seen in more detailed ovarian reserve testing, but not on baseline blood tests 

• Immune or clotting factors that need targeted panels to detect

These results aren’t uncommon or necessarily cause for concern - they just fall outside the first round of testing. That means you’ll need to partner with a doctor who's willing to keep looking - and healthcare coverage that supports follow-up testing.

What to ask your doctor if you have unexplained infertility

A few starter ideas:

• Ask what was tested and what wasn't – some clinics will hand you a summary that says "workup complete" without breaking down exactly which panels were run

• Ask about the next round of testing – laparoscopy if endometriosis is on the table, a full thyroid panel including antibodies, sperm DNA fragmentation testing if your partner's semen analysis was had notable results

• Get a second opinion if the answer stays "unexplained" after a second round of testing, because reproductive endocrinologists have different takes on  how far they'll go before recommending IVF

"Unexplained" has a frustrating and expensive cost structure. Every level of workup after the standard one is more expensive than the last, and your healthcare coverage (or ability to pay out-of-pocket) determines whether the next level of testing is possible. As a quick plug, a FLORA policy can be a great way to cover your costs if you get an infertility diagnosis later in life.

One last thing to remember

"Unexplained" is just a label, and what sits behind it is often a specific answer that hasn't been found yet.