My parents were married for 67 years. That is a very impressive accomplishment. Somehow they made it work although there was certainly a fair amount of yelling at times... How can you explain how to stay together for such a long time? In one sense it is unexplainable (certainly my wife will be hard pressed to suffer for 41 more years of Yoda impressions). But since it now hurts my vocal cords to say "Try not, do or do not. There is no try" we may not be headed to divorce court any time soon....
Infertility can also be unexplained. That doesn't mean untreatable. Just got a nice birth announcement from a couple with unexplained infertility who had failed 3 rounds of clomid/IUI and came to see me back in December 2012. All testing had been fine: normal HSG, normal semen analysis, normal ovarian reserve testing.
Why does CC/IUI fail? Good question. Perhaps the tubes (although open) failed to capture the egg(s). Perhaps the sperm failed to find the egg (they get lost, they die, they don't ask directions). Perhaps the sperm and the egg didn't like each other (What no flowers or box of chocolates?). Perhaps the egg didn't fertilize normally. Perhaps the embryo didn't grow normally. Perhaps the embryo failed to make it to the uterus. Perhaps the embryo failed to implant. All we can say after a failed IUI is that it failed.
IVF offers a chance to gain some additional information. Even if IVF fails, we can at least see if the egg looked OK, if the egg fertilized, if the embryo grew... Success rates for IVF increase with each hurdle that is cleared: successful retrieval, successful fertilization, successful embryo development, successful embryo transfer....
Given all these issues, my patient elected to pursue Natural Cycle IVF. She had considered FSH/IUI and stimulated IVF. Given her age of 37 she would be unlikely to end up with a high order multiple pregnancy with FSH/IUI but she and her husband were frustrated with the lack of information gleamed from IUI cycles. Stimulated IVF was an option but they elected to try NC IVF as a first step.
6 sonograms, 1 egg collection and 1 embryo transfer later they were pregnant and delivered a full term healthy baby recently. Score another victory for NC IVF. Remember that infertility may be unexplained but that doesn't mean untreatable.
Pray that I make it home to Maryland today. If you see a silver Murano in a ditch that could be me but I will channel my inner Boston driver and do my best to get home safely!
