Unexplained Infertility

Everybody’s experience of infertility is different, and this is just my own story. I guess it started when I got married in my early 30’s. Everything was going great, I loved my husband, my job and we were excitedly looking out for our dream home to buy together. We had decided jointly not to start a family until we had settled in our ‘forever home’, not really thinking my biological clock would be an issue! I had two close relatives with fertility issues, so I assumed I’d hardly be that unlucky to also have issues!   

Finally, everything seemed to be in place the summer I turned 35. We had an active sex life geared towards conceiving, I ate more healthily, took vitamin supplements developed for women trying to conceive, and hoped and prayed that it should take no longer than 6 months to a year to fall pregnant.  I had read in online literature that as I was over 30, I should expect it to take at least 6 months to fall pregnant. However, besides my relatively ‘older’ age I had no reason to suspect that we may have fertility issues. I had a healthy BMI and exercised regularly, I was fortunate to have a job I loved and no issues in my personal life to cause stress and I always had regular, reasonably heavy periods, without any associated issues to the best of my knowledge. 

However, after 6 months of ‘trying’ there were no missed periods. We went to the GP, and were recommended to keep trying for another 6 months and then we would be referred to a specialist if I had not fallen pregnant, as I was over 35 at this stage and officially ‘geriatric’ in terms of getting pregnant, to my shock and horror! Another 6 months went by, and this time I was using urine ovulation test kits every month to try and predict the best window to ensure we were having sex at the right time. There were still no missed periods.

After a year of ‘trying’, we were referred to a gynaecologist, as I was now 35 turning 36. I had a number of blood tests taken, a trans-vaginal scan, a cervical smear test and a hysterosalpingogram (HSG) x-ray.  My husband had a sperm test.  All the results came back as “normal”, so we at least could rule out any issues with my husband, and I was diagnosed with ‘unexplained infertility’, which is not uncommon in women over 35. As an extra precaution, I had my ovarian reserve (number of eggs in my body) tested privately, by measuring anti-Mullerian hormone levels in my blood and that came out at ‘low’, to my slight alarm. However, my ovarian reserve results were more or less in line with what one would expect for someone at my age at the time. 

In the first instance, for 6 months we were recommended to have intercourse every 2-3 days throughout my cycle. From day 2-6 of my cycle I was prescribed the oral medication clomiphene to promote ovulation. This is commonly prescribed to women who do not ovulate regularly or cannot ovulate at all. 

 After this period and with no pregnancy in sight, I had my follicles monitored for three months. This enabled the gynaecologists to identify the optimum time within my cycle for us to conceive. I had a transvaginal ultrasound at around day 10 of my menstrual cycle. My ovaries were monitored until a mature follicle had developed (greater than 16 mm endometrial thickness). When the egg was ready to be released from the follicle, I was asked to inject myself with human chorionic gonadotropin (HCG) to assist the process. We were recommended to have intercourse every 2-3 days throughout my cycle and increase this frequency around the time of ovulation. From day 2-6 of my cycle I was again prescribed the oral medication clomiphene.

Following that, I was prescribed an ovulation induction plan that involved stimulating the ovaries with follicle stimulating hormone (FSH) injections every other day from day 2-8 to develop an egg. On day 9 the ovaries were monitored with pelvic scans to check the development of the follicles. Once a mature follicle had developed, the stimulating injections were stopped, and an injection of HCG was given to release the eggs 35 hours later. 

After over a year of follicular monitoring, ovulation promotion and induction, I was still not pregnant and we were recommended to have in-vitro fertilisation (IVF), especially considering my age (at this stage nearly 38). I had been very fortunate up to this time not to feel any of the common adverse effects associated with the fertility treatments that I had been given, so the concept of IVF was not very daunting to me, but rather quite exciting. I know some other women personally who found each of the steps pre and post IVF very challenging both physically and emotionally, causing them to take time out in between the different stages of the IVF cycles. 

Before commencing IVF, I had a saline infusion sonography test which showed the presence of a small endometrial polyp in the wall of the womb. I then underwent a hysteroscopy under general anaesthetic to resection the polyp, as a precaution in case the polyp may interfere with a developing embryo.  I then commenced IVF and had one fresh cycle and one frozen embryo transfer cycle, which both failed unfortunately; however, we had a pair of healthy embryos from both cycles, so we were at least pleased with this much success. We then had to get treated privately and decided to have intracytoplasmic sperm injection (ICSI), which involved IVF and additionally the micro injection of my husband’s sperm into my eggs. This was a success the first time around and resulted in the conception and birth of our beautiful children, a boy and a girl. 

I was very fortunate that my local medical provider (NHS in the UK) funded all the procedures that I had to overcome my infertility other than the ovarian reserve test. I know other women who suffered from infertility in other countries and found the cost of the fertility treatments inhibitory in themselves and added to their stress. 

During the years of privately going through various procedures to help us conceive, we did come across some well-meaning people enquiring as to why we were ‘taking our time’ to have children. This was possibly the most difficult experience to deal with for me. I was fortunate not to find the hormonal treatments too difficult to manage psychologically, and after the first year of trying without success I was accepting that it may not happen to us, as was almost the case for my close relatives. I am aware that everyone experiences success and failure in different ways, and I always still felt fortunate that I had a loving, supportive husband by my side in any case. I wish every woman diagnosed with unexplained fertility every success in their efforts to conceive and accept the outcome whatever that may be.