Becoming a parent is usually thought of as a natural part of life, yet for many couples, the process isn't that easy. You might have taken every test, monitored every cycle, and done every doctor's recommendation—only to be informed that everything is normal. And yet, conception still doesn't occur. This infuriating and most of the time perplexing experience has a name: unexplained infertility. In contrast to conditions in which the etiology is obvious, unexplained infertility puts couples hunting for answers in reproductive medicine's gray areas. Diagnosis is often both a blessing and a reversal—relief that nothing appears "wrong," but distress that no obvious solution exists.

For most couples, parenthood is a journey of anticipation, planning, and hope. But what is a couple to do when there are normal test results, no medical red flags found by doctors, and yet no pregnancy? This is the frustrating, emotionally draining experience of unexplained infertility—a condition which brings couples more questions than answers.

During an interview with Dr. R. Suchindra, Senior Consultant – Reproductive Medicine, Milann Fertility Hospital, Bengaluru, he states, "Unexplained infertility is when a couple fulfills all the clinical criteria for natural conception—normal ovulation, normal sperm, patent fallopian tubes, and harmonious hormones—still does not conceive after more than one year of attempting to conceive under age 35, or six months above."

This paradox, too often underemphasized in the discussion of fertility, plagues couples around the globe and is becoming a growing public health issue. Infertility itself affects approximately 10–15% of married couples in India, yet as much as 30% of those cases qualify as unexplained. And although the term may sound final, doctors point out it is really more a matter of limitations in testing than an absolute lack of causes.

Why "Unexplained" Infertility Doesn't Mean "Hopeless"?

The phrase "unexplained infertility" may sound daunting, but it's worth recognizing that it doesn't equal a guarantee of impossibility. Rather, it denotes the realm of reproductive science as of today. Physicians claim that the condition is undeservedly named. What appears to be unexplained now can, in the course of time, turn out to be due to minute hormonal variations, egg or sperm quality problems, or even molecular immune responses that current testing cannot possibly measure.

Dr. Suchindra adds that medical technology is a large contributor: "The more sophisticated the diagnostic equipment, the fewer couples are in the unexplained category. Sometimes the cause is just concealed, not missing."

This is an important point because it reinterprets unexplained infertility as an obstacle to overcome—not an impossible one.

Hidden Causes Behind Unexplained Infertility

Though there is no one explanation, studies propose a cluster of underlying factors that could be responsible:

Latent Tuberculosis (Genital TB): Especially in South Asian nations, this latent infection can destroy the endometrium or fallopian tubes without overt symptoms.

Endometriosis and Muted Hormonal Disturbances: Disorders such as endometriosis, insulin resistance, or thyroid disease are not necessarily detected through regular checks but are able to interfere with ovulation and implantation.

Nutritional Deficiencies and Autoimmune Conditions: Deficiencies in some vitamins and minerals, celiac disease, diabetes, or autoimmune diseases like lupus and antiphospholipid antibody syndrome (APS) may interfere with reproductive processes.

Cervical Mucus and Immunological Factors: In certain instances, cervical mucus has antibodies that destroy sperm, a condition referred to as immunological infertility.

Egg and Sperm Quality: Counts of eggs and sperm motility can be measured, but quality is more difficult to quantify. Unhealthy eggs or undetectable sperm defects might be undetectable in routine reports but affect conception.

All of this serves to explain why unexplained infertility is still such a difficult diagnosis—because the causes are usually hidden beneath the surface.

The Emotional Burden of an Invisible Diagnosis

For couples, a diagnosis of unexplained infertility is more than a medical diagnosis—it's a psychological odyssey. A lack of obvious explanation can be followed by cycles of self-blame, anxiety, and uncertainty. There is no one to draw a roadmap for treatment in this situation, as there might be for other conditions, and so patients can feel helpless.

Dr. Suchindra stresses, "This is usually the most difficult aspect for couples. With no cause found, they are left stuck. But here's what to understand: Many couples with unexplained infertility do end up conceiving naturally or with some assisted help."

Support, counseling, and honest communication with the healthcare providers become as crucial as treatments.

Approaches That Can Improve Chances of Conception

The lack of a definite cause doesn't imply there's no hope. Indeed, a combination of lifestyle changes, medical surveillance, and new reproductive technologies usually enhances the chances considerably.

1. The Importance of Time and Patience

On occasion, physicians will suggest a "watchful waiting" plan. Couples who are less than 35 years old can be told to keep trying naturally for several more months and monitor ovulation carefully. Research indicates that spontaneous conception is possible in a high percentage of situations once tension is minimized and timing is refined.

2. Lifestyle Changes That Enhance Fertility

Having a healthy weight, consuming a healthy diet, smoking cessation, reducing alcohol, reducing caffeine intake, and engaging in stress-reducing activities like yoga or mindfulness can provide a conducive environment for conception. While these measures don't "treat" infertility, they improve overall reproductive health.

3. Medical Treatments and Assisted Reproductive Technology (ART)

When waiting and lifestyle modifications are not sufficient, physicians might prescribe treatments like:

Ovulation stimulation with medication to control or enhance egg release.

Intrauterine Insemination (IUI), wherein thawed sperm is inserted directly into the uterus when timed properly.

In Vitro Fertilization (IVF), which circumvents most natural obstacles by fertilizing eggs externally and transferring embryos.

All of them have varying success rates based on the couple's age, health, and duration of trying.

Reproductive medicine is developing fast. Genetic testing, artificial intelligence for embryo choice, and better understanding of immunological and metabolic causes of infertility will soon render the "unexplained" status much less frequent.

"Each year we find new layers of how the body prepares for pregnancy," Dr. Suchindra explains. "Our challenge as clinicians is to bridge that gap between what we know and what remains unknown, so couples can find clarity and hope."

Unexplained infertility can be a disquieting diagnosis, but it is not an impasse. Many couples still conceive naturally after a few months of waiting, while others succeed by adjusting their lifestyle and by using ART. What this process requires most is resilience, honest communication with the medical team, and the knowledge that reproductive science is continuously evolving.

As Dr. Suchindra stresses, "The lack of an answer today does not equate to the lack of a solution tomorrow." To couples on this journey, that message can convert doubt into potential.

After the Thanksgiving, on Friday, the Food and Drug Administration (FDA)'s top vaccine regulator, Vinay Prasad made a clam that shocked the public-health established. "For the first time, the US FDA will acknowledge that COVID-19 vaccines have killed American children," he wrote in a leaked email to his staff, as reported by The Atlantic and The Washington Post.

The agency has identified that at least 10 children died after getting COVID shots.

The email has been perceived by physicians as a "threat". A response from 12 former FDA commissioners, published in The New England Journal of Medicine on Wednesday, called Prasad's memo "a threat to evidence-based vaccine policy and public health security". All of the potential vaccine related deaths reported to government were already reviewed by the agency's staff, and had reached "different conclusions", wrote the former commissioners.

Elsewhere, doctors and scientists have declared that there are no evidence that links COVID-19 vaccines to deaths in children. The commissioners have claimed that in an attempt to deliberately bring evidence, Prasad and his colleagues had engaged in an "evidence-manufacturing mission", a "dumpster dive" for shoddy data, or worse, a campaign of lying.

Prasad is one of several public health officials who, under Robert F. Kennedy Jr.’s leadership, have been steadily chipping away at public trust in vaccines. So far, he has not provided evidence to back his claims, and his estimate of vaccine-related deaths may be exaggerated. The memo’s intense language and focus on political complaints also cast doubt on his assertions.

However, something that cannot be ignored is that fact that his memo may have provoked people to deny even the possibility of COVID-vaccine-related deaths. The Atlantic notes that "the idea that mRNA-based shots have, tragically, killed a very small number of children is not far-fetched." The article written by Benjamin Mazer, a physician who specializes in pathology and laboratory, notes that the this does not imply a "catastrophic threat to public health" as tens of millions of doses of the same vaccines have saved young people.

Understanding the Debate Of Vaccine-Linked Deaths

Public-health experts agree that COVID vaccines, like all medical treatments, can cause side effects. Myocarditis, a rare heart inflammation seen mostly in adolescent boys and young men after mRNA shots, remains the most discussed risk. Although usually mild and far less severe than virus-induced myocarditis, a few deaths have been documented worldwide, including isolated cases in the U.S., South Korea, and two American teenagers described in a peer-reviewed report.

These findings fuel ongoing debate about whether extremely rare vaccine-related deaths are being overlooked. Some scientists, including Paul Offit and Michael Osterholm, say the evidence does not prove the vaccines caused these deaths, noting that population-level studies show no rise in mortality after vaccination. Others argue that well-investigated autopsy-confirmed cases should be taken seriously rather than dismissed outright.

Experts such as Krutika Kuppalli, as cited by Mazer, emphasize that even if deaths occur, they are so uncommon they do not appear statistically, while the benefits, significantly reduced COVID mortality, are unmistakable. However, individual cases still raise questions on health authorities and the stricter standards of proofs they have applied when vaccines were involved to create a room for skepticism.

The concern is that rare side effects of vaccines could go undiscovered and not that vaccinations are inherently harmful.

Are you down with fever? Are your symptoms also a little less common from an ordinary cold? Are you also confused between flu and COVID? Then knowing this one symptom could help you set flu apart from COVID. Dr Rupa Parmar, a GP and medical director at Midland Health tells The Mirror, that shortness of breath could be a key symptom that could differentiate between the two.

Dr Parmar highlights that it is a key indicator for COVID. "Shortness of breath is rare in both a cold and the flu, but as COVID more so affects the lungs due to inflammation, it is a common symptom."

The NHS website supports her advice, noting that breathlessness is a symptom more often tied to Covid, not the flu or a common cold. This kind of breathing difficulty is usually associated with infections like Covid or respiratory syncytial virus (RSV).

What Else Could Help You Know If You Have A COVID or Flu?

The nature of your cough could also help you understand different ailments. Dr Parmar said that a cold would produce a mild cough, whereas a flu cough could be more dry. However, with covid, "a cough will be dry and continuous, and many people will cough for more than an hour or have three or more coughing episodes within a day."

If one has lost their sense of smell or taste, then the chances are, this could be COVID. However, this symptom is also present in cold or in a flu.

For people who have Covid, the NHS advises staying home and avoiding contact with others if they or their children have symptoms and either develop a high temperature or feel too unwell to work, attend school, manage childcare, or carry out daily activities. If you are unsure about the cause, it is important to speak with a doctor.

Dr Parmar emphasized: "after all, it is always better to be safe than sorry when it comes to health."

What Is Flu?

The flu is a common respiratory illness that happen from the influenza virus. The common flu symptoms are:

• Fever
• Sore Throat
• Runny Nose
• Fatigue
• Body Aches
• Cough
• Headaches

What Is COVID-19?

As per the US Centers for Disease Control and Prevention (CDC), COVID-19 is a respiratory illness caused by the coronavirus. The common symptoms include:

• Fever
• Cough
• Fatigue
• Headache
• Nausea
• Sore Throat
• Runny Nose
• Loss of smell or taste

COVID-19 could also have some long-lasting symptoms unlike flu or cold, that could seem unrelated to the original infection.

As per the Ohio State University, the most recent COVID variant is XFG or the Stratus variant. Another new variant that causes the 'razor blade' like sore throat is Nimbus.

The symptoms of this new variant includes:

• Congestion
• Cough
• Fever
• Headache
• Sore throat
• Muscle Aches

'Razor blade' Throat

NB.1.8.1 or the Nimbus variant is a subvariant of Omicron, which is a dominant COVID variant since late 2021. Omicron variants tend to cause more throat problems than the other variants seen earlier.

The COVID virus binds to ACE2 receptors. According to WebMD, the cells in your nose and throat contain more ACE2 receptors than those deeper in the lungs, which makes them easier targets for Omicron variants. Once the virus attaches to these receptors in the upper airway, your immune system begins to respond.

Ever since the Trump administration has come to power, sentiments against vaccines have gone up. Many vaccine critiques have been handpicked by the anti-vaxxer HHS Secretary RFK Jr. as health officials. So it is no surprise that now the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) is now recommending that mothers who test negative for hepatitis B should discuss the need for the vaccine with their doctors. If parents choose to delay the birth dose, the first shot should be given at no earlier than two months of age. This is dropping the longstanding hepatitis B vaccine guideline that stated that every newborn receive the first dose of the hepatitis B vaccine shortly after birth. This recommendation, in place since 1991, was reversed on December 5 after a key CDC advisory committee voted to change the policy.

This committee was appointed by Health and Human Services Secretary Robert F. Kennedy Jr., who dismissed all 17 previous members earlier this year. The shift in policy has triggered wide debate, especially in the medical community, because it overturns one of the longest standing infant vaccination guidelines in the United States.

Below are some of the claims made by the panel, both sides, who debated the vaccine's need or unimportance for all infants.

Hidden Hepatitis B Infections Make Risk Hard to Judge

Claim: Several ACIP members questioned whether babies considered “low risk” truly need a hepatitis B shot at birth. But hepatitis B is not always easy to detect or trace.

The virus spreads through bodily fluids such as blood, semen and vaginal fluids. It is also extremely resilient and can survive on surfaces for up to a week. Even tiny amounts of dried blood from everyday items like razors, toothbrushes or nail clippers can carry the virus.

Hepatitis B often has no symptoms for years. The CDC estimates that 640,000 adults in the United States live with chronic hepatitis B, and half do not know they are infected. This means that even if a mother tests negative during pregnancy, her newborn can still be exposed through family members or other caretakers. Before universal birth-dose vaccination began, only half of infected children under age ten had contracted the virus from their mothers at birth.

Because so many people are unaware of their infections, determining true risk is complicated.

The Vaccine Protects the Most Vulnerable: Newborns

Claim: Some committee members suggested that vaccinating all newborns mainly protects adults or others at higher risk.

That claim is misleading. The primary purpose of giving the shot at birth is to protect infants, who face the most severe long-term consequences of infection.

Hepatitis B attacks the liver. If an infant becomes infected, there is a very high chance the disease will progress into a chronic lifelong condition. About a quarter of those children eventually die prematurely from liver failure or liver cancer. While treatments exist to reduce complications, there is no cure.

Dr. James Campbell, a pediatric infectious disease specialist at the University of Maryland, reminded the committee that the vaccine strategy transformed public health outcomes. “We used to have 18,000 or 20,000 kids born with this every year, and a quarter of them would go on to develop liver cancer. We now have almost none,” he said.

Falling Infection Rates Show Vaccines Worked

Claim: Hepatitis B infections fell sharply after the birth-dose recommendation took effect. Before vaccination became routine, up to 300,000 Americans were infected annually. About 20,000 of those were children.

Today, total annual cases have dropped to around 14,000. Among people under 19, chronic infections have reached extremely low levels. In 2022, the CDC documented only 252 new cases in this age group.

ACIP member Dr. H. Cody Meissner, who voted against changing the policy, argued that declining numbers do not justify easing precautions. “It is a mistake to say that because we are not seeing much disease, we can change the schedule,” he said. “If we do, hepatitis B infections will come back.”

The United States Is Not an Outlier

Claim: Some committee members compared U.S. policy to countries such as Denmark, which does not vaccinate all newborns.

However, the United States is far from alone in recommending a universal birth-dose. According to CDC data from September 2025, 116 out of 194 World Health Organization member countries recommend hepatitis B vaccination at birth.

Denmark does not include hepatitis B in its standard childhood schedule, but it has a centralized national health system, higher prenatal screening rates and less fragmented medical records. The United States lacks these structural advantages, which makes relying solely on maternal testing more challenging.