Unexplained infertility
“Unexplained” is a diagnosis that many couples find harder to accept than a clear problem. It means the standard tests are normal, not that there is nothing to do. Dr. Shami's first step is to check that the workup was really complete; her second is a plan with clear stages.
What it means
Infertility is called unexplained when a couple has been trying for a year or more, ovulation is regular, the tubes are open, the uterus looks normal and the semen analysis is normal. It accounts for roughly one couple in four or five who seek help. In reality, the cause usually exists but sits below what routine tests can see: subtle problems with egg quality, fertilisation, embryo development or implantation.
Was the workup really complete?
Many couples labelled unexplained have never had a full assessment. Dr. Shami checks whether the tubes were actually tested, whether ovulation was confirmed rather than assumed, whether the semen analysis was repeated and read properly, whether the ovarian reserve is known, and whether endometriosis, which can be silent, has been considered. A surprising number of “unexplained” cases stop being unexplained at this stage.
What the numbers tell you
Age and how long you have been trying are the two facts that most change the outlook. A couple in their late twenties who have tried for a year has a good chance of conceiving without treatment in the next year. A couple in their late thirties who have tried for three years does not have time to wait. The plan follows the numbers, and Dr. Shami will show you yours.
How Dr. Shami approaches it
- 1
Re-examine before treating
The workup is completed or repeated where it was thin, so that treatment is not aimed at the wrong target.
- 2
Stepped, with time limits
Expectant management or timed cycles for a defined period, then ovulation induction with IUI for a defined number of cycles, then IVF. Each step has an agreed end date.
- 3
IVF as a diagnosis, too
When simpler steps have not worked, IVF often reveals the reason, in how the eggs fertilise or how the embryos develop. That knowledge shapes everything that follows.
Dr. Ghina Shami
Questions patients ask
Does unexplained mean there is no problem?
No. It means the standard tests cannot see the problem. Some causes, such as egg quality or fertilisation failure, can only be observed in the IVF laboratory.
Should we go straight to IVF?
Not necessarily. Depending on your age and how long you have been trying, timed cycles or IUI with ovulation induction may be a sensible first step. Dr. Shami will set a time limit for each step so that you are not stuck in one for years.
Could stress be the cause?
Stress does not cause infertility in the way people fear, though infertility certainly causes stress. Dr. Shami will not tell you to “just relax”; she will look for what the tests have missed.
Medically reviewed by Dr. Ghina Shami, Consultant Reproductive Endocrinology & Infertility · September 2026
Tell Dr. Shami where you are in your journey
A message on WhatsApp is enough to start. She replies personally, in English or Arabic.