Unexplained Infertility: When All Your Tests Are Normal

You've done all the tests. Your hormones look normal. Your tubes are open. Your partner's semen analysis is fine. And yet, month after month, you're not getting pregnant.

Unexplained infertility is one of the most frustrating diagnoses you can receive. It accounts for 10-30% of infertility cases, and it essentially means that conventional testing hasn't found a reason why you're not conceiving.

If you've been told everything looks fine while your body clearly isn't cooperating, you're not imagining the disconnect. Something is happening that the tests aren't measuring.

Unexplained doesn't mean unexplainable. It means the explanation hasn't been found yet. And there's more you can do than wait.

What Does Unexplained Infertility Mean?

To understand what might be missing, it helps to know what conventional testing is designed to find.

Ovarian reserve testing measures the quantity of eggs remaining. It gives you a sense of how many eggs you have, but it doesn't directly assess the quality of those eggs or how well they'll fertilize and develop. For more on this topic, read our article on how to improve egg quality.

Ovulation confirmation through progesterone levels or LH tracking tells you that you're releasing an egg, but it doesn't tell you whether the timing is optimal or whether your uterine lining is ready for implantation.

An HSG or sonohysterogram checks whether your tubes are open and your uterine cavity looks normal. It can identify obvious blockages or structural issues, but it doesn't detect subtle inflammation or assess how well the tubes are functioning.

Semen analysis measures count, motility, and morphology. These are important, but they don't capture everything about sperm health, including factors like DNA integrity that can affect fertilization and embryo development.

These tests are valuable for ruling out major issues. But they provide a limited picture. Many factors that influence fertility simply aren't measured in a standard workup.

What Causes Unexplained Infertility?

When testing comes back normal but conception isn't happening, something is still off. Here's what we commonly find when we look deeper.

Egg Quality Issues

Standard testing measures how many eggs you have, not how healthy they are. Egg quality is influenced by oxidative stress, inflammation, mitochondrial function, and the hormonal environment during the 90-day development window before ovulation.

A woman can have normal AMH and still have eggs that aren't developing optimally. This won't show up on blood work. It often only becomes apparent during IVF, when fertilization rates or embryo development reveal the issue.

Egg quality can be improved. The environment where your eggs develop responds to changes in sleep, stress, inflammation, and nutrition. Research published in Reproductive Biology and Endocrinology has shown that lifestyle interventions can positively impact markers of egg quality in as little as three months.

Chronic Stress and Nervous System Dysregulation

This is the factor we see most often in unexplained infertility.

These are women who have been pushing hard for years. Building careers, managing responsibilities, handling stress. Their bodies have adapted to running on adrenaline and cortisol. They've been in a low-grade stress state so long it feels normal.

Research published in Human Reproduction found that women with higher levels of alpha-amylase, a biomarker for stress, took 29% longer to conceive and had double the risk of infertility compared to women with lower levels. The study suggests that stress reduction should be considered as a potential way to improve fertility.

We often ask women: when was the last time you felt truly relaxed? Not on vacation, not after a glass of wine, but genuinely at ease in your body? Most can't remember. That tells us something important.

When the nervous system is stuck in this mode, it affects everything. Hormone balance. Digestion. Sleep. Blood flow to reproductive organs. The body is prioritizing survival, not reproduction.

Inflammation You Can't Feel

Low-grade inflammation can interfere with fertility at multiple levels. It affects egg quality, hormone signaling, and the uterine environment. Inflammation can come from diet, digestive health issues, food sensitivities, or chronic stress.

A study in the American Journal of Reproductive Immunology found that even subtle elevations in inflammatory markers were associated with reduced fertility in women with no other identifiable cause. The inflammation wasn't causing symptoms, but it was affecting conception.

You might not feel inflamed. But if you have bloating, food sensitivities, joint pain, skin problems, or fatigue, inflammation may be present and affecting your reproductive system.

Digestive Health and Hormone Metabolism

Your digestive system does more than process food. It plays a central role in hormone balance.

Your digestive system is where excess estrogen gets processed and eliminated. When digestion is sluggish or the microbiome is imbalanced, estrogen can recirculate instead of being cleared. This throws off the hormonal balance needed for ovulation and implantation.

Research in the Journal of Translational Medicine has demonstrated that the intestinal microbiome directly influences estrogen levels through what's called the estrobolome, the collection of bacteria that metabolize estrogen. An imbalanced microbiome can lead to hormonal disruption that affects fertility.

Digestive issues can also create low-grade inflammation throughout the body. Many women with unexplained infertility have digestive symptoms they've never connected to fertility.

Male Factors That Didn't Show Up

Standard semen analysis misses a lot. DNA fragmentation, which affects fertilization and embryo development, isn't routinely tested. A study in Fertility and Sterility found that sperm DNA fragmentation was significantly higher in couples with unexplained infertility compared to fertile controls, even when standard semen parameters were normal.

Oxidative damage to sperm can be significant even when count, motility, and morphology look normal.

When a couple receives an unexplained diagnosis, there may be contributing factors from both partners that testing didn't reveal. This is actually an opportunity. When both partners focus on their health, the results are often greater than either person working alone.

How to Treat Unexplained Infertility Naturally

When women come to us with unexplained infertility, we're looking for what the tests missed. We want to understand your health history, your current symptoms, your stress levels, your sleep, your digestion, and the details of your cycle. Often, patterns emerge that point toward what's actually happening.

Regulating the Nervous System

For most women with unexplained infertility, this is where we start. Chronic stress affects every system involved in conception. Acupuncture is one of the most effective tools for regulating the autonomic nervous system, shifting the body from stress response toward a state that supports reproduction.

The vagus nerve plays a key role here. It connects your brain to your digestive system and pelvis. When it's functioning well, your body can shift into rest, digest, and reproduce mode. Acupuncture has been shown to support vagal tone and improve blood flow to the uterus and ovaries.

Reducing Inflammation

We look for sources of inflammation: diet, digestive health, food sensitivities, chronic stress. Reducing inflammation improves egg quality, hormone signaling, and the uterine environment.

This often involves dietary changes, digestive support, and anti-inflammatory herbs or supplements tailored to your specific situation.

Supporting Digestion

If you have digestive symptoms, addressing them often improves fertility. Better estrogen metabolism, reduced inflammation, and improved nutrient absorption all contribute. When we address digestion, we often see improvements in cycle quality, energy, and overall health along with fertility.

Optimizing Your Cycle

Through acupuncture and Chinese herbs, we work on the quality of your cycle. Not just whether you're ovulating, but the strength of ovulation, the length of your luteal phase, the quality of your uterine lining. These details matter for implantation.

Can You Get Pregnant with Unexplained Infertility?

Yes. Many women with unexplained infertility go on to conceive, both naturally and with treatment.

Research supports acupuncture for unexplained infertility. A randomized controlled trial published in Fertility and Sterility found that women with unexplained infertility who received acupuncture had significantly higher pregnancy rates compared to those who did not. The study also found that acupuncture significantly reduced anxiety levels.

The proposed mechanisms include improved blood flow to the uterus and ovaries, regulation of the hypothalamic-pituitary-ovarian axis, and reduced stress hormones. These align with what we see clinically: when the nervous system settles and blood flow improves, fertility often follows.

What This Looks Like in Practice

A woman came to us at 34 after eighteen months of trying. She'd been diagnosed with unexplained infertility after a full workup. Her doctor had suggested IUI, but she wanted to understand why she wasn't conceiving before adding interventions.

When we talked, the picture became clearer. She worked 50+ hours a week and described herself as always on. She hadn't taken a real vacation in two years. Her sleep was light and restless, rarely feeling rested even after eight hours in bed. She had bloating after most meals and significant PMS for a full week before each period.

Nothing was technically wrong. But her body was showing clear signs of strain. She was exhausted at a level she had normalized, and her nervous system had been running in overdrive for so long she didn't know what settled felt like.

We started with weekly acupuncture focused on regulating her nervous system. Gradually, she began to settle. She started sleeping through the night. Her energy improved. We addressed her digestion with dietary changes and herbs, and the bloating resolved. Her PMS shortened from a week to a few days.

Her partner made changes too. He cut back on alcohol, improved his sleep, and started taking a male fertility supplement. They approached this as something they were doing together.

She conceived naturally in her fifth month of working with us. 

Her tests hadn't changed. But her body had shifted into a different state. Her nervous system settled. Her digestion improved. Her cycle became stronger. The conditions for conception finally aligned.

Read stories from women we've worked with →

If You're Considering IVF

Some women with unexplained infertility move forward with IVF. It can provide information about egg quality, fertilization, and embryo development that can't be assessed otherwise.

If you're considering IVF, we can support you through that process. The work of regulating your nervous system, reducing inflammation, and optimizing your health benefits IVF outcomes too. Many of our patients do both, using integrative support alongside their IVF cycles. To learn more, read our article on acupuncture and IVF.

Your Next Step

If you've been diagnosed with unexplained infertility, there's more to explore than what standard testing reveals. The answers are often in the places no one has looked yet.

We've worked with many women who came to us after this diagnosis, feeling frustrated and unsure what to do next. What they often needed wasn't more interventions. It was someone to help them understand what their body was actually asking for.

Learn more about our Fertility & Health path or contact us at 212.432.1110 or info@fafwellness.com.