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Rajeev Agarwal: All Reports Normal, Still Not Pregnant?
Rajeev Agarwal/LinkedIn
Nov 3, 2026, 17:29

Rajeev Agarwal: All Reports Normal, Still Not Pregnant?

Rajeev Agarwal, Director of Renew Healthcare, shared on LinkedIn:

” ‘All my reports are normal. Why am I not getting pregnant?’

Couples often bring me a file of normal reports and ask me this. About 1 in 3 couples who struggle to conceive are told it is ‘unexplained infertility’. I prefer to call it ‘not yet explained’. Usually it means the basic tests found nothing, not that nothing is there.

Before I accept that label, I check three things:

  1. How long you have really been trying, and the woman’s age.
    After a year of trying with normal reports, the chance of pregnancy each month falls to less than half of what it was. So waiting is not free. Time is part of the problem.
  2. Tuberculosis of the womb and tubes.
    It is far more common in India than in Western countries, and a normal tube test (HSG) does not rule it out.
  3. Mild endometriosis, if IUI has not worked.
    It usually does not show on a scan. In one review, more than 4 in 10 women with ‘unexplained’ infertility who had a keyhole operation (laparoscopy) were found to have it, mostly mild. If three good IUI cycles have not worked in a woman under 35, I still consider a laparoscopy, although European guidelines do not advise it routinely.

Two things I tell couples not to do:

  1. Do not wait two years ‘just to see’.
    UK guidelines still suggest two years of trying before treatment. In my practice, I finish the tests early, because couples in India often reach me later and older, and the tests are quick and affordable. Then we decide about waiting with real numbers.
  2. Do not pay for add-ons that have not proven themselves.
    A 2026 trial of 593 couples found that ‘endometrial scratching’ did not clearly increase live births.

What usually comes next:

If everything is truly normal, European and UK guidelines suggest IUI with fertility injections, for up to about four cycles, before moving to IVF. For younger couples with a good chance, research has not shown that treatment works better than giving it more time.

If you have been told ‘everything is normal’, share this with your partner before your next appointment.”

Rajeev Agarwal: All Reports Normal, Still Not Pregnant?

Other articles featuring Rajeev Agarwal on Fertility News.

Fertility Fertility News infertility Mild endometriosis OB-GYN Rajeev Agarwal reproductive health Reproductive Medicine unexplained infertility Women’s Health
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