Frontiers in Reproductive Health, 2026
RRM Academy Synopsis
Half of Unexplained Infertility Couples Conceived While Charting
These couples all had unexplained infertility and picked their own group. 21 of 41 couples who charted conceived within 12 months, 51.22%. In the assisted reproduction group, 10 of 56 conceived, 17.8%, over one complete treatment cycle.
Key Findings
- 21 out of 41 couples who tracked fertile days conceived within 12 months, a rate of 51.22%. In the assisted reproduction group, 10 of 56 conceived, a rate of 17.8%.
- Among women under 34, the pregnancy rate was 90.9% with fertility tracking and 30% in the assisted reproduction group.
- Among women aged 35 to 39, the rate was 36.7% with fertility tracking and 17.4% in the assisted reproduction group.
- The two rates cover different windows. The 51.22% is cumulative at 12 months. The 17.8% is counted over one complete treatment cycle, so the arms are not a like-for-like comparison.
- The authors suggest that couples with unexplained infertility, younger ones especially, may be advised to wait a further 12 months using fertility awareness.
Clinical Implications
Unexplained infertility means undiagnosed. The authors call for a full workup of both partners, male and female, before a couple is told the fastest route is straight to assisted reproduction. That order matters. Assisted reproduction goes around whatever is stopping conception and leaves it in place. Read the two rates with care. They cover different windows, and couples chose their own group. The firm figure is the tracking arm's own 51.22% within 12 months.
Study Notes
A study across several centers that followed couples forward in time. All had primary unexplained infertility. Researchers followed 41 couples using fertility awareness methods for 12 months. Pregnancies in that group were counted at 12 months. A control group of 56 couples went straight to assisted reproduction. Their pregnancies were counted over one complete treatment cycle. That group had been trying longer and had more prior cycles.
RRM Context
Restorative reproductive medicine asks why conception has not happened, then treats what it finds. Assisted reproduction bypasses that question. The pattern here fits what timing studies show. Marking the fertile window raises the chance of pregnancy in a given cycle. Male factor is solely responsible in about 20% of couples, so a workup that skips the male partner is incomplete on its own terms.
Abstract
Introduction
Couple infertility is a common clinical condition that is too often treated with assisted reproductive techniques (ARTs) without a proper evaluation of both male and female factors. To improve the likelihood of natural conception, fertility awareness methods (FAMs) are widely used.
Methods
We performed a multicenter prospective study enrolling couples with primary idiopathic infertility who were seeking natural conception. Participants were followed for 12 months using FAMs, and their outcomes were compared with those of couples who only used ARTs. The aim of our study was to evaluate the pregnancy rate after 12 months among couples with idiopathic infertility using FAMs compared with those who immediately pursued ARTs. We evaluated 41 couples in the FAM group and 56 couples in the ART group.
Results
In the FAM group, we reported a pregnancy rate (PR) of 51.22%. Among women aged <34 years, we reported a PR of 90.9%, while it decreased to 36.7% among women aged 35-39 years. In the ART group, 10 couples achieved pregnancy (PR 17.8%). Within this group, we reported a PR of 30% among women aged <34 years and 17.4% among women aged 35-39 years.
Discussion
After 12 months of unprotected intercourse without spontaneous conception in women younger than 35 years or after 6 months in women aged 35-39 years, couples should undergo a complete multidisciplinary diagnostic evaluation involving both the male and female partners. If a diagnosis of idiopathic infertility is established at the end of this process, couples (especially younger ones) may be advised to wait an additional 12 months while using FAMs, as no advantage has been observed with direct access to ARTs. They could then be referred to ART if a spontaneous pregnancy is not achieved during this period.
Cite this article
Barbato, M., Del Zoppo, S., Parazzini, F., Graziani, A., Guida, M., Ferlin, A., Frigerio, L., & Grande, G. (2026). Fertility awareness methods and waiting conduct in idiopathic infertility: a prospective observational study. Frontiers in Reproductive Health. https://doi.org/10.3389/frph.2026.1753325
Barbato M, Del Zoppo S, Parazzini F, Graziani A, Guida M, Ferlin A, Frigerio L, Grande G. Fertility awareness methods and waiting conduct in idiopathic infertility: a prospective observational study. Frontiers in Reproductive Health. 2026. doi:10.3389/frph.2026.1753325