As a fertility specialist in Hyderabad, I often meet couples who have done everything “right”  they’re healthy, they’ve been trying for a while, and all their basic reports come back normal. Their cycles are regular, their fallopian tubes are open, the sperm tests are fine, and the uterus looks good. And yet, pregnancy doesn’t happen.

When we don’t find a clear medical reason after a full evaluation, we call it unexplained infertility.

It may sound surprising, but 20 to 30% of couples I see fall into this category. And while the term “unexplained” can feel vague, it simply means that current testing methods haven’t identified a specific issue yet — not that there’s no path forward.

What could be happening behind the scenes?

There are many complex steps involved in conception that go beyond what routine tests can detect. For example:

• A woman may be ovulating, but the egg quality might be suboptimal.
• The fallopian tubes may be open but not functioning perfectly in picking up the egg.
• The sperm may reach the egg, but fertilization might not occur due to subtle biochemical factors.
• The embryo may not implant even if everything else appears normal.

Sometimes, we uncover more details only during an IVF cycle, where we get to observe how eggs fertilize, how embryos develop, and whether anything unusual occurs at that stage.

As I often tell my patients, “Not having a clear answer doesn’t mean we don’t have effective options. We tailor the treatment to your age, history, and goals.”

How we manage unexplained infertility

If a woman is under 35 and hasn’t undergone prior treatment, we may begin with controlled ovarian stimulation and intrauterine insemination (IUI). This increases the chances of conception by synchronizing ovulation and placing the best-quality sperm closer to the egg.

For couples who have already tried these methods, or if the woman is above 35, we may move directly to in-vitro fertilization (IVF). IVF gives us valuable insights into egg quality, fertilization, and embryo development, and often leads to higher success rates.

Why timing is important

Age plays a key role in fertility. If you're under 30, trying naturally for up to a year may be appropriate. But if you're 35 or older, even six months without success warrants evaluation by a fertility specialist. Starting early can make a big difference in outcomes.

A message of reassurance

Being told everything looks normal, yet pregnancy hasn’t happened, can feel confusing. But I want to reassure you — unexplained infertility has solutions, and many couples go on to have healthy pregnancies with the right care.

At Rainbow Hospitals, Hyderabad, we use advanced diagnostics, personalized treatment plans, and compassionate counseling to support every couple’s journey. If you're exploring your fertility options, I’m here to guide you with clarity, care, and hope.