Unexplained Infertility: What It Means and What to Do Next
By Dr. Harsimranjeet Singh Bhatia, ND · Last reviewed November 2026
The quick summary: Unexplained infertility is diagnosed when a couple has not conceived after a year of trying (or six months if the woman is 35 or older) and standard testing of ovulation, the fallopian tubes, the uterus and sperm comes back normal. It means a cause has not been found yet, not that nothing can be done. Dr. Harsimranjeet Singh Bhatia, ND helps people in Ottawa and across Ontario look more closely at the factors standard testing can miss, such as sperm DNA fragmentation, thyroid antibodies, blood sugar and iron, environmental exposures, metabolic health and much more to help build a plan that fits alongside your fertility clinic's next steps.
What does unexplained infertility mean?
A diagnosis of unexplained infertility means that the usual first round of fertility testing has not found a clear reason for difficulty getting pregnant. That standard workup usually includes confirming ovulation, checking that at least one fallopian tube is open, assessing the uterus with ultrasound, checking ovarian reserve, and a semen analysis.
Unexplained infertility accounts for roughly one in four couples seen for infertility. It is a diagnosis of what has been ruled out, not an explanation. Many couples with unexplained infertility do go on to conceive, either on their own or with treatment.
What can standard fertility testing miss?
Standard tests are helpful, but they do not look at everything. Depending on your history, Dr. Singh may requisition or review:
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Sperm DNA fragmentation (DFI) testing, since a standard semen analysis does not measure DNA damage in sperm
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Fasting glucose, insulin and A1c, to look at blood sugar regulation
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Ferritin, iron studies and vitamin D
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Autoimmune testing, when your history suggests it
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Additional specialized tests when they are indicated
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Cycle tracking and progesterone timing, to look for a short luteal phase
Some conditions need assessment by your physician or fertility clinic. Endometriosis often does not show on ultrasound and can be present without classic symptoms. Chronic endometritis, a low grade inflammation of the uterine lining, is tested through your physician. Endometrial microbiome tests are available through direct to patient lab kits. We cannot order them, but we are happy to review results you bring in.
What are the treatment options for unexplained infertility?
Medical treatment is always decided with your physician or fertility clinic. Depending on your age, how long you have been trying and your ovarian reserve, options they may discuss with you include:
Continuing to try naturally for a period of time, which your physician may feel is reasonable for younger couples with a shorter time trying
Ovulation induction with IUI, where your physician may discuss medication to support ovulation alongside a timed insemination
IVF, which your fertility clinic may discuss sooner when age or time trying is a concern
There is no single right answer. The best choice balances your age, your timeline, cost, and how you feel about each step.
How can naturopathic care help with unexplained infertility?
Naturopathic care fits around your fertility clinic's plan rather than replacing it. Care begins with a detailed review of both partners' history and testing to look for anything worth investigating further. From there, a plan may include clinical nutrition, diet and lifestyle support, attention to sleep and stress, and fertility acupuncture alongside IUI or IVF. Every recommendation is checked against your treatment protocol.
Male partners are part of the picture. Sperm take about three months to develop, so the months before a treatment cycle are a valuable window for both partners. Learn more on our male fertility page.
When should you move on from trying naturally?
A general rule is to seek assessment after 12 months of trying if you are under 35, after six months if you are 35 or older, and right away if you are over 40, have very irregular cycles, or know of a condition that affects fertility. With unexplained infertility, guidelines suggest that options such as IUI or IVF are worth discussing with your fertility clinic, especially as time trying grows longer or age becomes a factor.
What happens at your first visit?
Your first visit is 60 minutes. We review your fertility history and timeline, both partners' testing, cycle patterns, prior pregnancies, medications, supplements and lifestyle, and the questions you want answered. You leave with a prioritized plan, any requisitions you need, and clear points to discuss with your fertility clinic.
Current fees for each appointment type are shown when you choose a time on the online booking page. We do not direct bill, but you receive a receipt to submit to your insurer, and most extended health plans cover visits with a naturopathic doctor.
Frequently asked questions
Does unexplained infertility mean everything is normal?
Not necessarily. It means standard testing has not found a cause yet. There may still be contributing factors that need a closer look.
What is the success rate with unexplained infertility?
It varies widely with age and time trying. Many couples conceive naturally over time, and treatments your fertility clinic may discuss, such as IUI with ovulation induction or IVF, can improve the chances each cycle. Your fertility clinic can give you estimates based on your own situation.
Can stress cause unexplained infertility?
Stress alone is not considered a cause of infertility, but it can affect sleep, cycles, relationships and how well you manage through treatment. Support for stress is part of good care.
Should both partners be assessed?
Yes. Male factors contribute to infertility in a large share of couples, and a standard semen analysis does not capture everything.
Do you see patients virtually?
Yes. Appointments are available in person in Ottawa and virtually across Ontario. Acupuncture is offered in person in Ottawa.
About Dr. H. Singh, ND
Dr. Harsimranjeet Singh Bhatia, ND is an award winning naturopathic doctor in Ottawa who has focused on reproductive and hormonal health for over ten years. He has presented Grand Rounds to physicians at The Ottawa Hospital's Department of Obstetrics, Gynecology and Newborn Care and to physicians at the largest fertility clinic in Eastern Ontario, and he works collaboratively with fertility clinics and family physicians. He received the 2026 Emerging Leader Award from the Ontario Association of Naturopathic Doctors and was named Naturopath of the Year by Faces Magazine Ottawa in 2021, 2022, 2023 and 2024. He holds a BSc from the University of Guelph and graduated from the Canadian College of Naturopathic Medicine.
Medical disclaimer: This page is for general education and does not replace individual medical advice, diagnosis or treatment. Please speak with your physician or a qualified healthcare provider about your own situation before starting or changing any treatment, supplement or medication.
References
Guideline Group on Unexplained Infertility; Romualdi D, Ata B, Bhattacharya S, et al. Evidence-based guideline: unexplained infertility. Human Reproduction. 2023;38(10):1881–1890. doi: 10.1093/humrep/dead150.
Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertility and Sterility. 2020;113(2):305–322. doi: 10.1016/j.fertnstert.2019.10.014.
National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. NICE guideline NG257. Published March 31, 2026. https://www.nice.org.uk/guidance/ng257
Agarwal A, Majzoub A, Baskaran S, et al. Sperm DNA fragmentation: a new guideline for clinicians. The World Journal of Men's Health. 2020;38(4):412–471. doi: 10.5534/wjmh.200128.
Brannigan RE, Hermanson L, Kaczmarek J, Kim SK, Kirkby E, Tanrikut C. Updates to male infertility: AUA/ASRM guideline (2024). The Journal of Urology. 2024;212(6):789–799. doi: 10.1097/JU.0000000000004180.
Cicinelli E, Matteo M, Tinelli R, et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Human Reproduction. 2015;30(2):323–330. doi: 10.1093/humrep/deu292.
Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Human Reproduction Open. 2022;2022(2):hoac009. doi: 10.1093/hropen/hoac009.
Gaskins AJ, Chavarro JE. Diet and fertility: a review. American Journal of Obstetrics and Gynecology. 2018;218(4):379–389. doi: 10.1016/j.ajog.2017.08.010.