"Unexplained" means nothing was found, not that nothing is there
When women labelled unexplained are looked at surgically, something is found in about half.
Roughly 15% to 30% of couples come through a full evaluation with no abnormality found. They are then labelled unexplained, and the label starts to function as though it were a diagnosis.
A systematic review looked at what happens when women carrying that label undergo diagnostic laparoscopy:
| Found at laparoscopy in women labelled unexplained | Share |
|---|---|
| Endometriosis | 44%, of which 74% minimal or mild |
| Tubal factors | 20% |
| Adhesions | 16% |
| Any pelvic abnormality, no prior fertility treatment | 53% |
| Any pelvic abnormality, prior fertility treatment | 75% |
The authors note that despite decades of improvement in imaging, the prevalence of endometriosis and tubal abnormalities in this group remains high.
The fertility society is unusually candid about what follows from the label. Its guidance describes treatment of unexplained infertility as by necessity empiric
, which means treatment without an identified target. That word is doing a lot of work, and it belongs in your consent conversation.