Historically patients who were unsuccessful in trying to conceive came to our office for a fertility work-up that included Day 3 FSH and AHM levels, antral follical count and ultrasound-guided evaluation of the ovaries, an HSG and a semen analysis. If all of that testing came back with “normal” results the patient was often deemed to have “unexplained infertility” and was more than likely told to continue to try on their own with the expectation that it would happen…at some point.
But we now know that the diagnosis of “unexplained infertility” is inaccurate and frankly outdated. We know more scientifically today based on large studies that “normal” test results are not accurate positive predictors of good egg quality or ovarian reserve. Why do we continue to do these tests? Because when these tests come back “abnormal” they are accurate negative predictors. This information is critical and suggests that patients follow a more aggressive course like IVF.
What tests are relatively reliable? HSG’s (hysterosalpingogram), semen analysis and other screening blood tests of a woman’s general health are pretty sensitive. So when those tests are normal, we look for other factors – in most cases, once we have ruled out pathology in those areas, by process of elimination, we are left with the issue of egg quality or ovarian reserve. We now know that if someone has what appears to be “normal” test results but still is unable to conceive successfully, the likelihood is that they have diminished ovarian reserve (DOR). The “normal” results do not mean this is a mystery case – it means that there are fewer good quality eggs, so conception is much more difficult.
So what’s the take home message?
If all of your tests come back normal but you’re still unable to conceive, don’t be put off. Don’t let someone tell you that it’s all due to your stress or anxiety or worse, that you should “just relax”. Your instincts are correct – you likely need intervention. Don’t wait for ART help. Seek consultation with an REI – diagnosis and treatment is available. And time is critical.
Natalie A. Cekleniak, M.D., Natalie A. Cekleniak, MD, joined the Institute for Reproductive Medicine and Science in 2000 and currently serves as Practice Director. Dr. Cekleniak received her B.S. in molecular biology from Haverford College in 1989, and her medical degree from a combined program at Dartmouth Medical School and Brown University School of Medicine in 1993. She subsequently completed a residency in obstetrics and gynecology at Pennsylvania Hospital in Philadelphia, and a fellowship in reproductive endocrinology and infertility at Brigham and Women’s Hospital in Boston.