Unexplained Fertility

Why it’s not really “unexplained” and what to do when the answers just aren’t adding up.

What is Unexplained Infertility?

Unexplained infertility is a frustrating and confusing diagnosis that’s given when a couple has been trying to conceive for 6–12 months, and all “standard” fertility tests come back normal. Ovulation? Check. Fallopian tubes? Open. Semen analysis? Looks fine. Bloodwork? All in range.

And yet… still not pregnant.

Approximately 15–30% of couples experiencing infertility are told their case is “unexplained.” But here’s the thing: unexplained doesn’t mean unsolvable. It simply means conventional medicine hasn’t looked deep enough (yet).

In functional fertility care, we know that when you ask better questions—you get better answers.

What Are the Signs of Unexplained Infertility?

By definition, unexplained infertility doesn’t come with a clear red flag. But many of our clients know something feels “off”—even if they’re told everything looks “normal.”

🤷‍♀️ Regular periods, confirmed ovulation—but still not conceiving
🧪 Normal labs, normal ultrasound, normal semen—but still no baby
⏳ Trying for 6+ months (under 35) or 12+ months (over 35) without success
🧠 Feeling dismissed, gaslit, or told to “just keep trying”

You might even be told to move straight to IUI or IVF—without ever being given a real explanation why you’re struggling.

Who Gets Diagnosed With Unexplained Infertility?

Anyone can be diagnosed with unexplained infertility—especially if you haven’t had thorough testing beyond the basics. But you're more likely to get this label if:

🧍‍♀️ You’re under 35 and still within the “fertile window”
📉 Your labs are borderline but not outside the clinical range
💉 You’ve never had advanced hormone, immune, or nutrient testing
🧬 Male partner hasn’t had a DNA fragmentation test or functional sperm assessment
⚖️ You’re told everything looks fine—except the results (no pregnancy)

This diagnosis often becomes a catch-all for "we don’t know why you're not pregnant.” But you deserve to know.

What Causes Unexplained Infertility?

In our experience, most “unexplained” cases actually do have an explanation—it’s just not one that’s been tested for. Here are some of the most common root causes we uncover:

🧠 Subclinical Hormone Imbalances: You may be ovulating, but with low progesterone, poor egg quality, or an estrogen imbalance.
🧬 Poor Egg or Sperm Quality: Even if quantity is okay, quality is often overlooked—especially with oxidative stress, age, or environmental exposure.
🩸 Thyroid Dysfunction or Autoimmunity: Subclinical hypothyroidism or Hashimoto’s can disrupt cycles and implantation—even with a “normal” TSH.
🧫 Nutrient Deficiencies: Low B12, iron, folate, vitamin D, magnesium, or zinc can all affect egg maturation, sperm development, and implantation.
🦠 Gut or Vaginal Infections: Inflammation from gut dysbiosis, SIBO, candida, or vaginal dysbiosis can alter hormones, immunity, and the uterine environment.
🧪 Blood Sugar Imbalances or Insulin Resistance: Often missed if fasting glucose is the only test run.
⚠️ High Stress, Poor Sleep, or Cortisol Dysregulation: Your body may be ovulating—but in survival mode, it deprioritizes reproduction.
📉 Uterine or Endometrial Issues: Subtle lining problems, polyps, fibroids, or even undiagnosed Asherman’s syndrome.
🧍‍♂️ Male Factor Missed: Sperm quality (motility, morphology, DNA integrity) matters—even with a “normal” count.

In short: “unexplained” usually just means uninvestigated.

How is Unexplained Infertility Diagnosed?

Technically, it’s a diagnosis of exclusion—given when all of the following are considered “normal”:

✅ Regular menstrual cycles and confirmed ovulation
✅ Open fallopian tubes (via HSG or HyCoSy)
✅ Normal pelvic ultrasound (no fibroids, cysts, or endo visible)
✅ Normal basic bloodwork (FSH, LH, estradiol)
✅ Normal semen analysis from male partner

But here’s the catch: many of these tests are outdated, incomplete, or interpreted too loosely. That’s why we use more functional and integrative tools to get answers.

🩸 Comprehensive Hormone Testing: DUTCH, thyroid panel with antibodies, full progesterone tracking
🧬 Advanced Semen Testing: DNA fragmentation, oxidative stress markers
🧪 Mineral + Nutrient Testing: HTMA, OATs, micronutrient panels
🧫 Gut Testing: GI-MAP, SIBO breath tests, mycotoxin testing
🧠 Stress + Adrenal Function: Cortisol rhythm, HRV, nervous system patterns
🌿 Environmental & Lifestyle Review: Toxin exposure, sleep, stress, exercise, and cycle health

And other advanced testing.

This is what it really means to leave no stone unturned.

How Does Unexplained Infertility Affect Your Fertility Journey?

Unexplained infertility can leave you stuck in limbo—told to “just keep trying,” or to “go straight to IVF,” even though no one has explained what’s wrong.

💭 “Shouldn’t we try to fix something first?”
💭 “Is IVF my only option?”
💭 “Am I missing something no one’s looking at?”

You’re not alone—and you’re not crazy for asking those questions.

The good news: with the right approach, many of our clients with “unexplained” infertility conceive naturally. Others are able to use IVF more strategically—and more successfully—because the underlying issue was actually addressed.

We Can Help!

✨ One client was told she had unexplained infertility and would need IVF. We discovered low progesterone, thyroid antibodies, and post-pill PCOS. She got pregnant naturally in 4 months.
✨ Another couple had been trying for 2 years. With male factor ruled out, we uncovered hidden inflammation from gut dysbiosis and mold exposure. After a 3-month protocol, they conceived.
✨ A third client had “normal” labs—but our deeper testing showed mineral imbalances, high cortisol, and borderline low AMH. With targeted support, she conceived and carried to term.

At The Greenhouse, we specialize in the cases that don’t make sense—until they do. If you’ve been told it’s “unexplained,” let us help you find what’s actually going on.

👉 Apply for 1:1 fertility support

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References

Pandian, Z., Gibreel, A., & Bhattacharya, S. (2015). In vitro fertilisation for unexplained subfertility. Cochrane Database of Systematic Reviews, (11), CD003357. https://doi.org/10.1002/14651858.CD003357.pub4
Stephenson, M. D., & Fluker, M. R. (2000). Treatment of unexplained infertility with clomiphene citrate and intrauterine insemination: Results of a Canadian survey. Journal of Obstetrics and Gynaecology Canada, 22(8), 666–670.
Farquhar, C. M. (2015). Unexplained infertility. In Seminars in Reproductive Medicine, 33(1), 22–27. https://doi.org/10.1055/s-0034-1395280

**Not medical advice. Always consult your doctor before making changes to your health or fertility plan.