Unexplained infertility

To recapitulate, four questions must be raised when the couple has been evaluated and found to be normal: (1) Was the infertility evaluation complete in terms of modern standards? (2) Were the results of studies and observations appropriately interpreted? (3) Has a factor which was considered within normal limits and compatible with fertility at the onset of the workup changed during the course of the evaluation? (4) How accessible for evaluation are processes necessary for conception which occur within the reproductive tract? Both members of the couple as well as the managing physician are frustrated and plagued by feelings of inadequacy when no positive findings can be identified during the course of an infertility evaluation. This situation obviously requires of the physician a combination of delicacy, patience, and considerable attention to each detail of the evaluation which has just been completed. The material herein was designed to raise suggestions for approaches to such couples when faced with the designation of "unexplained infertility."