You probably know the statistics: more than a tenth of couples are involuntarily childless. This figure refers to Germany, but the situation is no different in Austria and Switzerland. All of these couples seek fertility counselling from a gynaecologist or other healthcare provider. In most cases, IVF follows very quickly. At the same time, standard tests are carried out to check the woman's hormone levels and for common problems such as malformations of the reproductive organs or endometriosis. If IVF also fails several times, the tests are extended. Karyograms are done, the man's sperm is examined and other tests are done for conditions that can affect fertility in both sexes. In most cases, a cause of infertility can be found. If a cause is found, specific treatment can be given, which usually results in pregnancy. If nothing is found, the couple leaves the clinic with a diagnosis of idiopathic subfertility.

What does it mean to have idiopathic subfertility?

When no cause can be found for a condition after a baseline evaluation, it is called idiopathic. In fertility treatment, about 20% of couples receive this diagnosis after the baseline evaluation. However, the diagnosis is not definitive. Idiopathic patients are tested for rarer and more specific conditions as treatment progresses. The percentage of couples with this diagnosis therefore decreases over time.

Subfertility is a decline in fertility. It is not the same as infertility. Very few people are 100% infertile. Pregnancy is definitely not possible for infertile people. For example, if you have had your womb removed because of cancer, you will not be able to get pregnant. However, subfertile people can still get pregnant, but the chances are lower than for fertile people.

Then it must be the psyche, right?

Now that most physical causes can be researched and studied down to the molecular level, many unexplained diseases are often blamed on the psyche. Depending on the disease, this may be justified, but in the case of idiopathic subfertility it is not.

Various reasons are given in the literature as to why the mind should play a role. For example, it is claimed that women are unconsciously afraid of the pain of childbirth or do not feel ready for the responsibility of having a child. Some even go so far as to claim that women who only want a child to save a broken relationship do not get pregnant because they do not really want the child itself.

There is no scientific evidence to support these claims. Although it is thought that severe stress can have a negative impact on fertility, this cannot be applied across the board to all couples with idiopathic subfertility.

In fact, couples who are involuntarily childless for a long period of time are strongly stigmatised by their environment because of the above-mentioned allegations. They are made to feel that they are doing something wrong. Family members, friends and colleagues are constantly coming round the corner with rather unhelpful advice such as 'why don't you relax', 'you should stop eating this or that' and so on. This eventually leads to couples blaming themselves or each other for the situation.

The psyche is still an important factor

Even without the social stigma, idiopathic subfertility is an enormous burden. By the time the diagnosis is made, the couple will have tried countless natural methods and probably a few IVF treatments. There is great hope before each attempt and even greater disappointment afterwards. So the couple has all sorts of tests done to find the cause of the problem. But even these are unsuccessful. There is hardly a situation in which people feel more helpless than when they are suffering and there is not even a logical reason for it.

This situation puts an enormous strain on both partners and usually on the relationship. In this sense, the psyche plays a role in that you need to take care of your mental health in order not to break down in this situation. That is why it is important to talk to your partner. Only by communicating your feelings can you respond to each other's needs. In addition, many couples with an unfulfilled desire to have children attend support groups or therapy. You should not be afraid to do this, because whether or not your mind is affecting your pregnancy, your mental health is important.

Can you get pregnant despite idiopathic subfertility?

The answer is yes. The University of Oxford published a major study on this in 2016. The study looked at how many couples who had been diagnosed with idiopathic subfertility were later able to conceive naturally. Only natural conception was looked at. Couples who had undergone IVF or similar treatments were not included in the study.

First of all, we need to clarify what 'later' means. It is generally recommended to have an examination if there is no pregnancy after about half a year of regular unprotected sex. After these tests, a diagnosis is made. In the study, couples in the Netherlands were followed for two years from that point. Couples who were found to have other causes of infertility, such as blocked fallopian tubes or motile sperm, were excluded from the study.

A total of 4999 couples were able to take part in the study. Within the first eight months of the study, 21% of the women became pregnant despite subfertility. Based on the results of the study, a calculation model was created to predict the probability of different scenarios. On average, 27% of couples with unexplained subfertility become pregnant within the first year. Over time, the likelihood of pregnancy decreases, but a significant proportion still achieve pregnancy. Even after one and a half years, the proportion is still 13% (see https://pubmed.ncbi.nlm.nih.gov/27993999/).

As mentioned above, this study looked at natural conception. The benefit of IVF in the context of unexplained subfertility has not yet been clarified. However, it does not appear to significantly improve the chances of success.

Studies like this show that a diagnosis of idiopathic subfertility is no reason to give up hope. It is important to remember that subfertility does not mean infertility. As long as you are not pregnant, you should definitely consider further tests at your fertility clinic. You may also want to take part in a clinical trial. Don't neglect yourself and your mental health during this stressful time. If you are indeed pregnant, your child will be lucky to have a healthy mother.