The Myth of "Unexplained" Infertility

Why "Everything Looks Normal" is often the hardest diagnosis to hear

Some diagnoses hurt not because something is wrong, but because nothing seems to be.

When couples are told "everything looks normal," it is often treated as the end of the conversation when, in truth, it may only be the beginning.

 When the Reports Are Normal, but Life Isn't

 In fertility clinics, 'unexplained infertility' is a real medical category. It means that standard evaluations of ovulation tests, semen analysis, tubal patency, and ultrasound findings have not revealed an obvious cause, but this does not mean that nothing can be discovered in the future.

 And yet, for the person sitting across the desk, it rarely feels neutral.

 It feels like being told:

• Your pain has no name.

• Your waiting has no explanation.

• Your body is fine, so why isn't your life moving forward?

  
  

I have met many individuals and couples for whom this diagnosis brings not relief, but quiet despair. Because at least a diagnosis gives direction. "Unexplained" gives silence.

A Story We See Often (and Rarely Talk About)

Savitri and Ramesh came to Santaan Clinic from a village near Balasore. They were young, healthy, and deeply rooted in routine and ritual, early mornings, temple visits, meals grown from their own land, yet their hopes for a family persisted.

For three years, they had been trying to conceive.

They had already travelled to a large city clinic, spent a significant part of their savings, and returned with a thin file and a heavy word stamped across it: "Unexplained Infertility."

 "All your reports are normal," they were told.

 "Just relax. It will happen when it's meant to."

 But back home, the silence in their courtyard felt louder each day. Questions from neighbours. Avoided eye contact at family gatherings. Savitri slowly began to feel as though her body had failed at something everyone else seemed to do without effort. Ramesh, unable to "fix" anything, carried his helplessness quietly.

 They didn't need reassurance.

 They needed understanding.

 What "Unexplained" Actually Means in Medicine

 From a scientific standpoint, unexplained infertility does not mean:

• There is no cause

• Nothing can be done

• It is "all in the mind."

It simply means that our routine tools have limits.

Standard fertility tests are designed to identify common problems, but human reproduction is far more nuanced than averages and reference ranges. Subtle issues with timing, implantation, hormonal rhythms, sperm–egg interaction, or endometrial receptivity often do not show up on basic investigations.

 In other words:

Unexplained often means undiscovered.

 The Question We Ask Differently

When Savitri came to Santaan, we did not begin by repeating the same checklist. Instead, we slowed down.

 We asked:

• How does your body usually feel throughout your cycle?

• When do symptoms change?

• What patterns have been overlooked because they don't fit the textbook?

To explain it to Ramesh, we used a metaphor he understood instinctively.

 "Think of it like paddy farming," we said.

 "The soil may be fertile. The seed may be strong. But if the sowing happens at the wrong time, the crop will struggle, not because anything is wrong, but because the rhythm wasn't honoured."

What Science Found Quietly, Precisely

With deeper cycle tracking, advanced imaging, and careful hormonal correlation, we discovered something subtle but crucial: Savitri's implantation window opened later than the average timeline most protocols assume.

 Not a disease.

 Not a defect.

 Just a body following its own clock.

 This is where modern reproductive medicine is evolving, towards individualised, data-informed care, rather than one-size-fits-all timelines.

 No surgery was required. No dramatic intervention. Just alignment.

What Science Knows and What It Is Still Learning

What We Know

• Fertility is not only about organs, but about timing, communication, and biological coordination.

• Many cases labelled "unexplained" do respond to personalised treatment strategies.

• Stress alone does not cause infertility, but emotional burden can worsen the experience of it. 

What is still evolving:

• Our ability to precisely predict implantation windows

• Understanding micro-level endometrial and immune factors

• Long-term emotional outcomes of prolonged diagnostic uncertainty

Being honest about uncertainty is not a weakness of medicine. It is an act of respect.

 Beyond the Body: The Invisible Weight

 Infertility reshapes identity.

 People begin to see themselves as:

• The one who couldn't

• The couple is still waiting.

• The topic everyone whispers about

There is physical fatigue, yes, but also social withdrawal, financial strain, and quiet grief that doesn't fit into rituals of mourning.

 A compassionate fertility practice must hold all of this, not just lab values.

 Where This Story Is Now

 Savitri is currently 14 weeks pregnant.

 But the most important change came earlier.

 She once said, softly:

"For years, I thought I was cursed. Now I understand, it was just a timing issue someone finally took the time to find."

 This is not a promise. Every fertility journey is different. Outcomes vary. Hope must always be grounded, never guaranteed.

 But clarity itself can be healing.

A Gentle Closing Thought

If your reports say "normal" but your heart feels unheard, you are not imagining things. Often, you are responding to a gap between what has been measured and what still needs time, context, and careful attention.

At Santaan Clinic, fertility care is not a single test or a fixed protocol. It is a collaborative process, between science and sensitivity, between clinician and patient, between data and lived experience. We take the time to listen, to look beyond averages, and to recognise that everybody carries their own rhythm.

Not every fertility journey leads to the same outcome, and no clinic can—or should—promise that it will. What we can promise is respect, transparency, and thoughtful care, grounded in evidence and delivered with compassion.

Because while every story unfolds differently, no one should feel invisible while living it.