How can such wide discrepancies in the percentage of unexplained infertility be explained?
Obviously, if one considers, as has been proposed, a semen analysis, evaluation of ovulatory function, a post coital exam, a hysterosalpingogram, and a laparoscopy a complete initial assessment in any couple not conceiving in one year of attempting, a larger number of patients will be diagnosed as unexplained infertility than if additional tests are included or a longer period of infertility is required before making the diagnosis. If one accepts an abnormal parameter as an explanation, expanding the diagnostic tests only slightly reduces “unexplained” infertility dramatically as shown, for illustrative purposes, in the attached table from my own practice. Apart from the definition of infertility itself, an additional consideration would be the definition of test normals in any given practice or clinic. For example, if one uses 60% sperm motility of grade three plus as the lower limits of normal and accepts that any lower value may be associated with infertility, many otherwise “unexpl
