Around one in 7 couples that require artificial reproductive treatment (ART) have "unexplained" infertility and doctors often first use approaches like ensuring the female partner's ovulation occurs at the same time as natural sex or artificial insemination/intrauterine insemination (IUI). They may then recommend IVF where thousands of the male partner's best sperm are purified and incubated with the egg — this is the preferred initial ART procedure in cases of "unexplained" infertility.
There is a risk of multiples, which includes twins, triplets, or more. Multiple pregnancies can be risky for both the babies and the mother. It's important to discuss with your doctor how many embryos to transfer, as transferring more than necessary will increase your risk of conceiving twins or more. When embryos have been tested with PGT, typically only a single embryo is transferred.
A closer look at the data suggest that the benefit of letrozole over clomid depended on the BMI of the participants. For patients with a BMI of less than 30 kg/m2, the cumulative live birth rate was approximately 30% for each group. However, for patients with a BMI over 30 kg/m2, twice as many patients had a live birth in the letrozole group than the clomid group.
Risk of multiples. IUI with fertility medication carries a significant risk of multiple pregnancies, including higher-order multiples (triplets or more). A good clinic will carefully monitor your follicles to make sure that only a safe number are mature before the IUI, but they cannot entirely eliminate the risk. Recent advances in IVF (including blastocyst transfer) mean that most modern fertility clinics now transfer only one or two embryos per IVF cycle. As a result, the risk of multiple pregnancies for IVF patients is much lower than it used to be.
IUI: An IUI can be done with no medications or a number of different medications to help develop and ovulate one or two eggs. Around day 14 of a woman’s cycle, the insemination takes place which deposits sperm inside the uterus. This greatly increases the number of sperm at the junction of the uterus and fallopian tubes, the distance they have to swim to meet the egg, and thus increases the chances of natural conception for many people.
One in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. Infertility is defined as the inability to get pregnant after regular sexual intercourse without the use of any contraceptive methods for 6 months for those 35 years old or over, or 12 months for those under 35.(1)  Under normal circumstances the ability to get pregnant is at the most 25% each month. This number declines over time and starts to decline more rapidly once a women reaches her thirties, so that by age 35, the likelihood of getting pregnant each month is down to about 15%, and by age 40 it’s down to less than 10%.

Deciding whether to undergo in vitro fertilization, and how to try if the first attempt is unsuccessful, is an incredibly complicated decision. The financial, physical, and emotional toll of this process can be difficult. Speak with your doctor extensively to determine what your best options are and if in vitro fertilization is the right path for you and your family. Seek a support group or counselor to help you and your partner through this process.


Luteal support is the administration of medication, generally progesterone, progestins, hCG, or GnRH agonists, and often accompanied by estradiol, to increase the success rate of implantation and early embryogenesis, thereby complementing and/or supporting the function of the corpus luteum. A Cochrane review found that hCG or progesterone given during the luteal phase may be associated with higher rates of live birth or ongoing pregnancy, but that the evidence is not conclusive.[79] Co-treatment with GnRH agonists appears to improve outcomes,[79] by a live birth rate RD of +16% (95% confidence interval +10 to +22%).[80] On the other hand, growth hormone or aspirin as adjunctive medication in IVF have no evidence of overall benefit.[30]
If you’re worried that you might be an infertile woman, don’t lose your hope. Be encouraged, and know that many women get pregnant even after being diagnosed with infertility. Know that there is a reason for what you’re going through. I trust God and I rely on His power, peace, and joy every day. I know there is a reason why we struggled with infertility – and perhaps the reason is so I could write about fertility and encourage couples like you to keep the faith.

Women who switch from IUI to IVF sooner or begin with IVF get pregnant quicker than those who stick or start with IUI. One study found that undergoing immediate IVF resulted in superior pregnancy rates with fewer treatment cycles compared to those who did two rounds of IUI before switching to IVF.  While the immediate IVF group got pregnant quicker, the overall success after up to 6 IVF cycles was similar.
Time. The factor of time cuts both ways when you are weighing up these two options. IUI is a much shorter process than IVF, so if your first cycle is successful, it could be the quickest route to bringing home a baby. However, because of the gap in success rates between the two treatments, some patients in their late 30s to early 40s may get pregnant faster by going directly to IVF rather than waiting until they have had several failed IUI cycles.
Talk it out. Once you realize you’re entitled to your emotions, find an outlet for them. Talking about your feelings and your struggles can be a huge release and allow you to receive the support you need. If your family or friends don’t understand your sadness (or you find it hard to contain your baby envy around friends with more than one child), seek out people in your same situation. Find a support group for people with secondary infertility — online or in your area. And consider joining WTE's Trying to Conceive group to find moms who are also coping with secondary infertility.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
One of the worst parts of infertility – or the fear of being infertile – is friends and family members getting pregnant accidentally! “Today, my child-hating friend who vowed never to have kids no matter what, announced that she’s pregnant,” says Charity. “I’ve had three IVF (in vitro fertilization) cycles, spent $90,000 in fertility treatments, and still can’t conceive a baby. WTF?”

3-6 months of treatment with Clomid pills (clomiphene citrate) might improve fertility by as much as 2 times as compared to no treatment. This is a very low level infertility treatment. Infertility specialists do not usually recommend Clomid treatment( without insemination) for unexplained infertility for women over the age of about 35. Most fertility specialists do not use it (without IUI) on any couples with unexplained infertility. If a woman is already having regular periods and ovulating one egg every month, giving Clomid, which will probably stimulate the ovaries to release 2 or 3 eggs per month (instead of one) is not really fixing anything that is broken - and is not likely to be successful.
If both partners are young and healthy and have been trying to conceive for one year without success, a visit to a physician or women's health nurse practitioner (WHNP) could help to highlight potential medical problems earlier rather than later. The doctor or WHNP may also be able to suggest lifestyle changes to increase the chances of conceiving.[62]
In cases where the man's sperm count is extremely low or there is poor motility (movement of the sperm), doctors may combine IVF with a procedure called intracytoplasmic sperm injection. In this procedure, a sperm is taken from semen -- or in some cases right from the testicles -- and inserted directly into the egg. Once a viable embryo is produced, it is transferred to the uterus using the usual IVF procedure.
First, consider where the information about the success rates is coming from. Generally speaking, IVF success rates in the United States comes from the clinics themselves or from the Center for Disease Control and Prevention. The Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine both contribute to the CDC data.
Antiphospholipid syndrome (phospholipid antibody syndrome or Hughes syndrome) is an immune system disorder with symptoms that include: excessive blood clotting, miscarriages unexplained fetal death, or premature birth. In antiphospholipid syndrome, these symptoms are accompanied by the presence of antiphospholipid antibodies (cardiolipin or lupus anticoagulant antibodies) in the blood. Treatment focuses on preventing clotting by thinning the blood with the use of anticoagulants and aspirin.

While PGD was originally designed to screen for embryos carrying hereditary genetic diseases, the method has been applied to select features that are unrelated to diseases, thus raising ethical questions. Examples of such cases include the selection of embryos based on histocompatibility (HLA) for the donation of tissues to a sick family member, the diagnosis of genetic susceptibility to disease, and sex selection.[97]
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