Why is nothing working?

Clearly the million dollar question that all patients usually ask is "why is it not working?" The "it" can range from natural attempts at conception up to and including IVF. In some cases we really don't understand what the problem is and are faced with approaching fertility treatment with the "more eggs, more sperm...in the right place at the right time" approach. This logic is really the basis of most of our treatments. However, paradoxically we often recommend the most expensive and invasive treatment to those without an identifiable problem..why? Are we just a bunch of greedy, money grubbing slime bags?? Yes....no wait that describes only a few of us (just kidding, I hope). So why the aggressive approach in these cases? Well, here's the problem. If a couple fails to conceive on their own or after an IUI we have learned nothing new.

Did the egg ovulate? Unknown.
Did the tube catch the egg? Unknown.
Did the sperm find the egg? Unkown.
Did the sperm fertilize the egg? Unknown.
Did the egg divide? Unknown.
and so on...

At least with IVF we can provide some answers to the above questions.

So that leads to today's Question of the Day....and for all those who read this blog (besides my Mother) and have copies of the book, how about some 5 star reviews on Amazon.com? You don't usually have to beg for reviews but hey, I need that $0.27 per book to pay for my new laptop. So here is today's question:

68. Why would my doctor suggest IVF if all of my tests are normal?

Upon completion of the diagnostic evaluation, approximately 10% to 15% of couples will be found to have unexplained infertility, meaning that all of their tests are normal. Such couples are probably best called “subfertile,” and most can successfully conceive with IVF. Prior to the introduction of IVF, couples with unexplained infertility had a poor chance of achieving pregnancy with other treatment methods. We do not know precisely why couples with unexplained infertility are infertile. Some evidence suggests that the source of the problem may be tubal dysfunction or sperm egg interaction. Often, an infertility center uses IVF together with ICSI in such couples to ensure that fertilization of the ova occurs. Thanks to these techniques, today couples with unexplained infertility have a very strong likelihood of ultimately achieving a successful pregnancy with IVF.