You’ve done the tests. You’ve tried the timing. You may have even made lifestyle changes, taken supplements, or tried alternative therapies. But still, no pregnancy. And then you hear the words: unexplained infertility.

Few phrases in the fertility world are more frustrating — or more common. Up to 1 in 4 couples who struggle to conceive receive this diagnosis. But what does “unexplained” really mean? And what are your options if you’ve landed here?

In this post, we’ll unpack the reality behind unexplained infertility, explain how it’s diagnosed, and explore why IVF (in vitro fertilisation) can still be a powerful next step — even when the answers feel unclear.

What Is Unexplained Infertility?

“Unexplained infertility” is a diagnosis given when standard fertility testing doesn’t reveal a clear cause for why you’re not getting pregnant.

That means:

• You’re ovulating regularly

• Your fallopian tubes are open (confirmed by HSG or laparoscopy)

• Your partner’s semen analysis is normal

• Your ovarian reserve is within expected range for your age

And yet — no pregnancy, despite a year of trying (or six months if you’re over 35).

It’s essentially a process of elimination: no obvious red flags, yet conception hasn’t happened.

Why Is It So Frustrating?

Because it leaves you in limbo.

Many people feel a sense of relief when a clear diagnosis is found — PCOS, endometriosis, low sperm motility — because at least there’s something to treat. Unexplained infertility, by contrast, can feel like a door without a handle. You’re stuck without a reason, and that lack of clarity can be emotionally exhausting.

It also raises difficult questions:

• Are the tests missing something?

• Is there a subtle issue with egg or sperm quality?

• Is it an implantation issue that standard tests don’t detect?

• Is stress or immune response playing a hidden role?

Unfortunately, many of these possibilities can’t be definitively confirmed with current medical tools — which is part of what makes this diagnosis so complex.

How Is Unexplained Infertility Diagnosed?

There’s no single test for it — it’s a conclusion reached after several others come back normal. Typical work-up includes:

1. Blood tests: Checking hormones like AMH, FSH, LH, TSH, prolactin, and oestradiol.

2. Ultrasound: Monitoring the ovaries and uterus for any structural issues.

3. HSG (Hysterosalpingogram): Ensuring the fallopian tubes are open and the uterus looks normal.

4. Semen analysis: Assessing sperm count, motility, and morphology.

5. Ovarian reserve testing: Including AMH and antral follicle count.

If all these tests are normal and you’ve been trying to conceive for over a year (or six months if you’re over 35), doctors may diagnose unexplained infertility.

Can IVF Help?

Yes — and often, it’s very effective.

Even without a clear problem to fix, IVF can bypass several steps where things might be going wrong. For example:

• It ensures eggs and sperm meet (in case fertilisation is the hidden issue)

• It allows embryologists to assess embryo quality in the lab

• It sidesteps possible issues with cervical mucus, sperm transport, or egg pickup

• It gives insight into how many embryos develop, how they grow, and whether implantation might be a challenge

IVF Success Rates for Unexplained Infertility

For many people with unexplained infertility, IVF success rates are relatively high — especially when age and ovarian reserve are favourable. Some clinics also offer mild IVF or natural IVF cycles, particularly for people who prefer a gentler approach or have a lower response to stimulation.

In some cases, IVF is paired with ICSI (injecting sperm directly into the egg) if there’s any suspicion of a fertilisation issue.

Are There Any Other Options?

Before IVF, some people try:

• Clomid or Letrozole (ovulation induction medications) with timed intercourse

• IUI (intrauterine insemination), especially if you’re younger and have no known barriers

• Lifestyle changes, acupuncture, or stress reduction — although evidence is mixed

However, these options may have lower success rates than IVF, especially after age 35 or if you’ve been trying for more than 2–3 years.

Emotional Toll of the Unknown

Unexplained infertility can feel like an emotional paradox: you’re grieving something that has no name. Friends and family may say, “But there’s nothing wrong — just relax!” which only adds to the isolation and invalidation.

It’s okay to feel angry, confused, or betrayed by your body. It’s okay to want more answers than medicine can currently provide.

Support groups, fertility counselling, and peer communities (like Instagram, Reddit, or in-person groups) can be invaluable in helping you feel less alone on this part of the journey.

Unexplained infertility doesn’t mean your struggle isn’t real — it means the cause is currently invisible, not imaginary.

If you’ve received this diagnosis, it’s not a dead end. IVF, and even basic fertility treatments, can still lead to success. Many couples and individuals go on to have children after receiving this frustrating label.

You deserve support, clarity, and hope — even in the grey areas.