Unexplained infertility – debate continues

The paper discusses the ongoing debate about how to define and evaluate unexplained infertility, reviewing current standard infertility workups and arguing that important uterine, endometrial, and intraperitoneal abnormalities may be missed when diagnosis is made by exclusion. It summarizes recommended evaluation elements (e.g., semen analysis, ovulation assessment, HSG, and sometimes ovarian reserve tests and laparoscopy) while highlighting limitations that routine tests may not detect endometriosis without endometrioma and subtle uterine defects, and notes that guidelines have not clearly deliberated on whether hysteroscopy (or laparoscopy) should be mandatory before labeling unexplained infertility. A key theme is that a substantial fraction of infertility cases attributed to “unexplained” causes may instead involve uterotubal-peritoneal factors, and the authors emphasize the importance of tubal function and tuboperitoneal relationships alongside tubal patency. Relevance to endometriosis: the paper states that endometriosis is among the most frequent reasons for unexplained infertility and cites that infertility prevalence rises to 25–50% in women with infertility-associated endometriosis, while also arguing that laparoscopy may be the only way to detect endometriosis without endometrioma, even though its main focus is the diagnostic controversy around unexplained infertility.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works