Unexplained infertility is one of the most frustrating diagnoses you can receive when you’re trying to conceive. It’s doesn’t give any answers – and, for many, very little hope.

 

According to the NHS, “In the UK, unexplained infertility accounts for around 1 in 4 cases of infertility. This is when no cause can be identified in either partner.” The guidance then states that if a couple hasn’t conceived after two years of regular, unprotected sex, they should be referred for IVF (although this is also age dependent).

The NICE guidelines also state that drugs like clomifene citrate (commonly known as Clomid) should not be routinely offered for unexplained infertility, as they haven’t actually been shown to improve pregnancy rates compared withcontinuing to try naturally. I know this to be true – I was offered Clomid myself, and it didn’t help. In fact, it made me feel even more unhappy and frustrated with my body when we still didn’t conceive.

What Standard Testing Typically Covers

Before receiving the unexplained infertility label, couples usually go through some basic tests:

• Hormone testing (FSH, LH, oestrogen, progesterone)

  

• Thyroid-stimulating hormone (TSH)

• A basic semen analysis

• An ultrasound or hysterosalpingography (HSG) to check if the uterus and fallopian tubes are structurally sound

If all of these come back “normal” and you’re still not pregnant, you may be told it’s “unexplained.” But there’s a lot more that can be explored.

4 Often-Overlooked Areas That Can Impact Fertility

These are just a few of the most common areas of fertility health I explore with my clients (which commonly haven’t been looked at before they refer you for IVF!):

1. Vaginal and Uterine Microbiome Testing

These tests assess whether beneficial lactobacilli dominate the environment — and whether there are less helpful strains, like Gardnerella or Prevotella, which have been linked to longer time to pregnancy and less favourable outcomes. The good news? If we find imbalances, we can treat and rebuild – improving your fertility landscape.

2. Comprehensive Hormone Testing

We go beyond the basics. DUTCH testing or extended blood panels can show the full hormone picture, including testosterone, prolactin, SHBG, and key nutrient markers like B12, folate, vitamin D, and iron – all vital for reproductive health.

3. Sperm DNA Fragmentation Testing

Even if a semen analysis comes back “normal,” the sperm may have damaged DNA. This test tells us

more about the quality, not just the quantity or motility. The right nutritional and lifestyle changes can often make a big difference.

4. Nutrigenomic Testing

Genetic variations in methylation, hormone regulation, detoxification, and antioxidant pathways can all influence fertility. Nutrigenomic testing helps create a personalised nutrition and supplement plan that’s tailored to your unique biology – and your partner’s too.

Case Study

My client Anna had been trying to conceive a sibling for her son for two years with secondary unexplained infertility. A vaginal microbiome test revealed her positive lactobacilli were depleted and some less positive (dysbiotic) strains had proliferated. The dysbiotic strains were impacting her lactobacilli and therefore the environment for conception and pregnancy to take place. These bacteria are associated with longer time to conception and less beneficical outcomes. A month after completing the treatment to clear the dysbiotic bacteria, Anna had conceived. She’s now proud mama of a little sister for her son.

You Deserve Better Than “Unexplained”

You don’t have to accept “unexplained infertility” – you can find answers and you can support and optimise your fertility . There are real, evidence-informed steps we can take to uncover what’s going on and support your body to a place where it is ready for conception and a healthy pregnancy.

If you’re ready for a deep dive into what’s really going on in your body – and want someone to help navigate that with you with empathy and expertise – I’d love to speak with you. Click Here to Book a free chat so you can explore and support what might be holding you back.