For individuals experiencing difficulty getting pregnant without a clear explanation, additional testing helps investigate potential causes of infertility. Unexplained infertility often involves prolonged unsuccessful attempts to conceive, prompting healthcare providers to recommend further diagnostic evaluations. Explore additional testing options for individuals experiencing infertility without an established diagnosis:
Why Standard Testing Isn’t Enough
Healthcare providers typically conduct standard fertility testing after 12 months of unsuccessful attempts to conceive, or after six months for individuals aged 35 and older. These evaluations assess common factors affecting fertility, including ovarian reserve, embryo quality, and the timing of embryo transfer. Semen analysis is also requested to identify potential male-factor infertility. When standard testing does not reveal an identifiable cause, the condition is classified as unexplained infertility.
In vitro fertilization (IVF) is another treatment option for individuals experiencing infertility. Although IVF offers a pathway to conception, treatment outcomes vary depending on the underlying cause of infertility. Conditions such as endometriosis sometimes occur without noticeable symptoms, and routine fertility evaluations do not always identify these underlying factors.
During the initial examination, healthcare providers also conduct a lifestyle assessment to evaluate potential contributors to infertility. Factors such as tobacco use, alcohol consumption, drug use, diet, and physical activity are reviewed alongside medical history and standard test results. When these evaluations do not establish a diagnosis, additional specialized testing, including genetic screening and endometriosis assessments, helps investigate other potential causes of infertility.
How Inflammation Affects Fertility
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, causing inflammation that affects nearby reproductive organs and other areas of the body, including:
- Ovaries
- Fallopian tubes
- Various pelvic structures
- Intestines
Chronic endometritis is inflammation of the lining, which can prevent the embryo from implanting in the uterus. This condition creates a poor environment for conception, including the development of adhesions around the fallopian tubes to block the transfer of the embryo. Even a successful IVF transfer may fail because the embryo fails to implant correctly.
What Progesterone Resistance Is
Progesterone is a hormone naturally produced by the body that prepares the uterine lining for embryo implantation. During each menstrual cycle, the uterine lining sheds and rebuilds in preparation for the next ovulation period. Progesterone resistance occurs when the uterine lining responds inadequately to the hormone; this makes it more difficult for an embryo to implant and receive the nutrients needed for early development. Because progesterone levels may remain within the normal range despite this resistance, standard hormone testing does not always identify the issue.
Specialized fertility tests investigate specific factors associated with unexplained infertility. Testing for the BCL6 marker helps identify signs associated with progesterone resistance and endometriosis. Testing for the CD138 marker evaluates chronic inflammation by identifying plasma cells in the uterine lining. An increased presence of CD138-positive plasma cells indicates possible chronic endometrial inflammation.
Additional testing also helps identify silent endometriosis, a form of the condition that occurs without common symptoms such as pelvic pain or irregular periods. When left undiagnosed, endometriosis is associated with difficulties conceiving naturally and reduced success rates with IVF treatment. A confirmed diagnosis also helps healthcare providers evaluate appropriate treatment options.
What Treatment Is Available
Additional testing is a key step in identifying potential causes of infertility that standard diagnostic protocols do not detect. After reviewing the results, the healthcare provider develops a treatment plan based on the findings and individual reproductive needs. If specialized testing indicates endometriosis, surgical laparoscopy may be recommended to remove endometrial tissue while providing further confirmation of the diagnosis. Hormone suppression therapy is another treatment option that helps limit the growth of endometrial tissue, stabilize the uterine lining, and reduce inflammation. For chronic endometritis, antibiotics help address the underlying infection and inflammation; this potentially helps improve uterine health and supports the chances of successful embryo implantation during IVF treatment. Early identification and appropriate treatment also help guide future fertility care and inform decisions about additional reproductive interventions.
Seek Help for Unexplained Infertility
If standard tests haven’t provided a reason for a patient’s infertility, additional testing may be needed to reach a diagnosis. Patients should talk to their doctor about the possibility of silent endometriosis or progesterone resistance. Request testing to identify the cause of infertility and develop a treatment plan that supports successful conception.
