Highly effective therapy for even the most difficult male cases now is available. Infertility of unknown cause, which results from omission of tests, error in interpretation or inadequacies of current diagnostic methods, is classified as unexplained. About 15 percent of infertile couples fall into this category. Empiric treatments for unexplained infertility involve interventions that increase numbers of oozytes exposed to sperm cells each month. While imprecise, such empiric therapies, when carefully selected, expedite pregnancy.
Unexplained infertility is very frustrating for patients because of the uncertainties involved.
An abnormal postcoital test is diagnostic of cervical factor infertility. Although the utility of the postcoital test is limited, it has a place in infertility evaluation because it is noninvasive, relatively inexpensive, and leads to a simple therapy of intrauterine insemination that is effective when a cervical factor is the sole reason for infertility. If the remainder of the infertility evaluation is normal, intrauterine insemination with the husband's seminal plasma-free sperm is used to bypass the hostile cervical mucus. Intrauterine insemination is successful in treating 30 to 40 percent of couples with uncomplicated cervical factor infertility. Predictable and reproducible pregnancy rates following IVF have simplified infertility diagnosis but introduce additional complexity into counseling.