Unexplained infertility means that common fertility assessments have not identified a clear reason for difficulty conceiving. These assessments may include ovulation and hormone testing, ovarian reserve testing, imaging of the uterus and fallopian tubes, and a semen analysis.

It does not mean that nothing is wrong—or that pregnancy is impossible. Conception depends on many steps, and not every factor can be fully measured by standard testing.

A detailed review may consider:

• Age and how long you have been trying
• Menstrual cycle and ovulation patterns
• Egg quantity and ovarian response
• Uterine and fallopian tube findings
• Sperm count, movement and shape
• Previous pregnancies or miscarriages
• Medical history, medications and lifestyle factors

If you are under 35 and have been trying for 12 months, or 35 or older and have been trying for six months, consider seeking a fertility evaluation. Earlier assessment may be appropriate if cycles are irregular, periods are very painful, or there is a known reproductive concern.

Longevity Fertility Centre provides personalized fertility care in Calgary and Edmonton.

Request a consultation to discuss your fertility history and next steps.

Both can cause painful periods and pelvic pain, but they affect different locations.

Adenomyosis

• Tissue like the uterine lining is found within the muscular wall of the uterus.
• Often associated with heavy bleeding and painful periods.
• May cause pelvic pressure, bloating or an enlarged, tender uterus.

Endometriosis

• Tissue similar to the uterine lining grows outside the uterus, commonly on the ovaries or lining of the pelvis.
• May cause painful periods, pain during sex, or pain with bowel movements or urination.
• Can cause inflammation, scar tissue and ovarian cysts called endometriomas.

The conditions can occur together. Symptoms overlap, and some people have few or no symptoms.

How are they assessed?
Your medical history, examination and ultrasound can help guide assessment. MRI may be useful in selected cases. A normal scan does not rule out endometriosis; laparoscopy may sometimes be recommended.

Treatment depends on your symptoms, findings and pregnancy goals. If you are trying to conceive, discuss this before choosing treatment.

Persistent period pain, heavy bleeding or difficulty conceiving deserves assessment by a healthcare professional.

Timing matters when testing reproductive hormones because levels naturally change throughout the menstrual cycle.

FSH, LH and estradiol (E2):
These are usually tested during the early follicular phase, on cycle day 2, 3 or 4. Cycle day 1 is the first day of full menstrual bleeding. These results may help evaluate baseline ovarian function, ovulation patterns and hormonal balance.

Progesterone:
Progesterone is usually checked approximately seven days after ovulation, when it is expected to be near its peak. This is often cycle day 21 for someone with a regular 28-day cycle—but day 21 is not appropriate for everyone.

For example:
• 28-day cycle: test around day 21
• 35-day cycle: test around day 28
• Irregular cycles: timing may require ovulation tracking or individualized instructions

Hormonal medications and fertility treatments can affect test results. Your results should be interpreted together with your cycle history, symptoms and other fertility assessments.

Speak with your healthcare provider to determine the most appropriate testing time for your cycle.

The endometrium is the inner lining of the uterus where an embryo needs to implant and develop.

When the endometrium is very thin, implantation may be more difficult because the uterine lining may not provide the most supportive environment for an embryo.

A thin endometrium may be associated with:
• Reduced blood flow to the uterine lining
• Previous uterine procedures or scar tissue
• Low estrogen levels
• Chronic inflammation or infection
• Certain medications or hormonal conditions

In fertility treatment, endometrial thickness is often monitored by ultrasound before ovulation or embryo transfer. While pregnancy can still occur with a thinner lining, implantation and pregnancy rates generally tend to decrease as the lining becomes very thin.

The cause of a thin endometrium is important. Treatment depends on the underlying reason, so further evaluation may be recommended if the lining remains persistently thin.

If you are trying to conceive and have concerns about your endometrial thickness, speak with your fertility specialist for an individualized assessment.

Asherman’s syndrome is a condition in which scar tissue, or adhesions, forms inside the uterus. These adhesions can partially or completely affect the uterine cavity and may interfere with normal menstruation and fertility.

Common causes may include:
• Dilation and curettage (D&C), especially after pregnancy
• Uterine surgery
• Infection involving the uterus
• Procedures that affect the uterine lining

Possible symptoms include:
• Very light periods or no periods
• Increased menstrual cramping
• Difficulty becoming pregnant
• Recurrent miscarriage

Asherman’s syndrome may sometimes be suspected after an ultrasound or saline sonogram, but hysteroscopy is generally considered the most direct way to evaluate the uterine cavity.

Treatment often involves hysteroscopic removal of the adhesions. Depending on the severity of the scar tissue and the condition of the endometrium, fertility and menstrual function may improve after treatment.

If your periods have become unusually light or absent after a uterine procedure, speak with your fertility specialist or gynecologist for further assessment.

A semen analysis is one of the most important tests used to evaluate male fertility. It provides information about several key sperm parameters, including:

• Semen volume
• Sperm concentration and total count
• Motility — how well sperm move
• Morphology — sperm shape and structure
• Other findings that may affect fertility

An abnormal result does not automatically mean that pregnancy is impossible. Sperm parameters can vary over time and may be influenced by illness, fever, lifestyle, medications, heat exposure, and other health factors. In some cases, a repeat semen analysis may be recommended.

Male fertility is an important part of a complete fertility evaluation, especially when a couple has been trying to conceive without success.

Atypical endometrial hyperplasia (AEH), also called endometrial intraepithelial neoplasia (EIN), is a condition in which the cells of the uterine lining (endometrium) grow abnormally and show precancerous changes.

AEH is not the same as endometrial cancer, but it is considered a precancerous condition because it carries a significant risk of progressing to cancer. In some patients, an early endometrial cancer may already be present when AEH is diagnosed, which is why proper evaluation and follow-up with a gynecologist are essential.

Possible symptoms include:
• Irregular or prolonged periods
• Heavy menstrual bleeding
• Bleeding between periods
• Postmenopausal bleeding
• Difficulty conceiving in some patients

Treatment depends on age, medical history, and fertility goals. Hysterectomy is the definitive treatment. For selected patients who wish to preserve fertility, progesterone-based treatment with careful endometrial monitoring and repeat biopsies may be considered under specialist supervision.

If future pregnancy is important, fertility planning should be discussed early as part of the treatment plan.

These three tests may be used during a fertility evaluation, but each provides different information.

HSG (Hysterosalpingogram)
An HSG uses X-rays and contrast dye to examine the uterine cavity and determine whether the fallopian tubes are open or blocked. It is particularly useful when evaluating possible tubal-factor infertility.

SHG (Sonohysterogram / Saline Infusion Sonography)
An SHG uses ultrasound while sterile saline is placed inside the uterus. This helps provide a clearer view of the uterine cavity and lining and may identify polyps, fibroids, scar tissue, or abnormalities in the shape of the uterus.

Transvaginal Ultrasound (TVUS)
A transvaginal ultrasound uses an ultrasound probe placed in the vagina to examine the uterus, endometrial lining, ovaries, and follicles. It can help assess conditions such as ovarian cysts, fibroids, follicle development, and antral follicle count.

In simple terms:
• HSG: Are the fallopian tubes open?
• SHG: What does the inside of the uterus look like?
• TVUS: What do the uterus, ovaries, lining, and follicles look like?

Your healthcare provider may recommend one or more of these tests depending on your fertility history and individual needs.

Diminished Ovarian Reserve, commonly called DOR, means that the ovaries may have a lower number of remaining eggs or may respond less strongly to ovarian stimulation than expected for a person’s age.

DOR may be identified through a combination of age, medical history, AMH and FSH blood tests, antral follicle count, menstrual history, and previous fertility treatment response. A low AMH result alone does not determine egg quality or mean that pregnancy is impossible.

Because every fertility journey is different, test results should be reviewed as part of the complete clinical picture. An individualized plan may help clarify priorities, timing, and available fertility-care options.

Body mass index (BMI) is one factor that may influence reproductive health in both women and men.

In women, a higher BMI may affect hormone balance, menstrual regularity, ovulation, egg quality, and the body’s response to fertility treatment. It may also increase certain health risks during pregnancy.

In men, a higher BMI may be associated with lower testosterone, reduced sperm count or movement, increased sperm DNA damage, and sexual health concerns. However, these effects vary from person to person.

BMI is only a screening measurement. It does not fully reflect body composition, overall health, age, medical conditions, nutrition, stress, or other factors that influence fertility. Many people with a higher BMI conceive naturally, while people in other BMI ranges may still experience fertility challenges.

When appropriate, gradual and sustainable lifestyle changes may support metabolic and reproductive health. Fertility care should always be individualized rather than based on BMI alone.