Unexplained Infertility, the Controversial Matter in Management of Infertile Couples

30 % of infertile couples worldwide are diagnosed with unexplained or idiopathic infertility and the problem is defined as the lack of an obvious cause for a couple's infertility and the females ’ inability to get pregnant after at least 12 cycles of unprotected intercourse or after six cycles in women above 35 years of age for whom all the standard evaluations are normal. The veracity of ‘unexplained infertility ’ term has been chal-lenged by many clinicians and researchers; they emphasize that the assignment of this title to an infertile couple is much dependent on the quantity, quality and nature of the applied diagnostic tests (1, 2). According to the ESHRE guidelines, necessary tests for unexplained infertility are semen analysis, assess-ment of ovulation and the luteal phase, and assessment of tubal patency by hysterosalpingogram or laparos-copy. However, there are controversial opinions about the value of endometrial biopsy, ovarian reserve (AMH, AFC), post-coital test and serum prolactin levels. Our inability to find the causes of couples ’ infertility does not mean that there is no cause for the disorder. Extensive research should be conducted on other possible causes of failed conception such as ovarian and testicular dysfunctions, sperm and oocyte quality, fallopian transport defects, endometrial receptivity, im-plantation failures, and endometriosis (3, 4). Management of infertile couples with idiopathic cause needs individualized treatment. Several key varia-