Female Infertility: Causes, Symptoms, Tests and Treatment Options

Female infertility is common and can have many different causes. Problems with ovulation, age, the fallopian tubes, uterus, hormones, or conditions such as PCOS and endometriosis may affect a woman's ability to become pregnant.

Trying to get pregnant can be an exciting time, but it can also become stressful when pregnancy does not happen as quickly as expected. If you have been trying to conceive without success, you may find yourself asking, “Why am I not getting pregnant?” or “Could I have a fertility problem?”

The good news is that many causes of female infertility can be identified and treated. Even when the exact cause is not immediately clear, there are several fertility treatment options that may help.

What Is Female Infertility?

Female infertility refers to difficulty becoming pregnant despite having regular, unprotected sexual intercourse.

Infertility is generally considered after:

• 12 months of trying to conceive if you are under 35.
• 6 months of trying to conceive if you are 35 or older.

Women over 40 may benefit from speaking with a doctor sooner rather than waiting several months.

Female infertility can be caused by problems with ovulation, egg quality, the fallopian tubes, uterus, cervix, hormones, or other aspects of reproductive health.

It is also important to remember that infertility is not always caused by the woman. Male factors contribute to infertility in many couples, so evaluating both partners is often important.

How Common Is Female Infertility?

Difficulty becoming pregnant is relatively common. Fertility can be affected by many factors, including age, medical conditions, lifestyle, reproductive health, and the health of the male partner.

Some women have an identifiable cause of infertility, while others may have more than one contributing factor.

In some couples, no specific cause is found despite appropriate testing. This is known as unexplained infertility.

Having difficulty getting pregnant does not mean that pregnancy is impossible. Many women with fertility problems eventually conceive naturally or with medical treatment.

What Causes Female Infertility?

There are many possible causes of infertility in women. Some affect the release of an egg, while others affect the fallopian tubes, uterus, ovarian reserve, or the ability of a fertilized egg to implant.

The most common causes of female infertility include:

• Ovulation problems
• Polycystic ovary syndrome (PCOS)
• Endometriosis
• Blocked or damaged fallopian tubes
• Age-related decline in fertility
• Reduced ovarian reserve
• Uterine fibroids or other uterine problems
• Hormonal disorders
• Previous pelvic infections
• Certain medical conditions
• Lifestyle and environmental factors

Let's look at some of these causes in more detail.

Ovulation Problems and Female Infertility

Ovulation is the process in which an ovary releases an egg. For pregnancy to occur naturally, an egg generally needs to be released and available for fertilization.

If ovulation is irregular or does not occur, becoming pregnant may be more difficult.

Signs that ovulation may not be regular include:

• Irregular periods
• Very long menstrual cycles
• Missed periods
• No periods
• Difficulty predicting when your period will come

Hormonal problems, PCOS, significant changes in weight, thyroid disorders, and other conditions can interfere with ovulation.

PCOS and Infertility

Polycystic ovary syndrome (PCOS) is one of the common conditions associated with ovulation problems.

Women with PCOS may ovulate less frequently or irregularly. As a result, it can take longer to become pregnant.

PCOS may also be associated with:

• Irregular periods
• Acne
• Increased facial or body hair
• Weight gain or difficulty losing weight
• Insulin resistance

Having PCOS does not mean that you cannot become pregnant. Many women with PCOS conceive naturally or with appropriate fertility treatment.

Endometriosis and Infertility

Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus.

It may affect fertility in several ways. Endometriosis can cause inflammation, scar tissue, adhesions, or changes around the ovaries and fallopian tubes.

Common symptoms include:

• Painful periods
• Pelvic pain
• Pain during sexual intercourse
• Pain during bowel movements or urination during periods
• Difficulty becoming pregnant

Not every woman with endometriosis will experience infertility. However, if you have endometriosis and are trying to conceive, discussing your fertility with a doctor may be helpful.

Blocked Fallopian Tubes

The fallopian tubes connect the ovaries to the uterus and provide the usual pathway for the egg and sperm to meet.

If a fallopian tube is blocked or damaged, sperm may not be able to reach the egg, or a fertilized egg may not be able to travel normally toward the uterus.

Blocked fallopian tubes can occur because of:

• Previous pelvic infections
• Sexually transmitted infections
• Endometriosis
• Previous pelvic or abdominal surgery
• Pelvic inflammatory disease

An HSG (hysterosalpingogram) is one test that may be used to check whether the fallopian tubes are open.

Age and Female Fertility

Age is an important factor in female fertility.

A woman is born with a limited number of eggs. Over time, both the number and quality of eggs decline.

Fertility generally begins to decrease gradually during the early 30s and becomes more noticeable after the mid-30s. The decline becomes more significant as women approach 40.

Age can affect:

• The number of available eggs
• Egg quality
• The chance of conception
• The risk of miscarriage
• The likelihood of chromosomal abnormalities

This does not mean that pregnancy is impossible at an older age. However, if you are over 35 and are having difficulty conceiving, it is sensible to seek medical advice sooner.

Reduced Ovarian Reserve

Ovarian reserve refers broadly to the number of eggs remaining in the ovaries.

Ovarian reserve naturally decreases with age, although the rate of decline differs from woman to woman.

Tests such as AMH (anti-Müllerian hormone) and an ultrasound assessment of the ovaries may be used as part of a fertility evaluation.

However, no single test can perfectly predict whether a woman will become pregnant naturally. Test results need to be interpreted along with age, menstrual history, medical history, and other fertility factors.

Uterine Problems and Female Infertility

Problems involving the uterus may sometimes make it more difficult to become pregnant or maintain a pregnancy.

Possible causes include:

• Certain fibroids
• Polyps
• Scar tissue
• Congenital abnormalities of the uterus
• Other structural problems

Not every uterine abnormality causes infertility. Your doctor can determine whether a particular finding is likely to affect your chances of pregnancy.

What Are the Symptoms of Female Infertility?

Female infertility often has no obvious symptoms. The main sign is difficulty becoming pregnant after regular, unprotected sex.

However, some symptoms may indicate an underlying condition that could affect fertility.

These include:

• Irregular menstrual periods
• Very painful periods
• Absent periods
• Very heavy menstrual bleeding
• Pelvic pain
• Pain during sex
• Symptoms of PCOS
• Previous pelvic infections
• A history of reproductive surgery

Having one of these symptoms does not automatically mean that you are infertile. It simply means that it may be worth discussing your reproductive health with a doctor.

How Is Female Infertility Diagnosed?

A female infertility evaluation usually begins with a detailed medical history and physical examination when appropriate.

Your doctor may ask about:

• Your age
• Menstrual cycle
• Previous pregnancies
• How long you have been trying to conceive
• Previous surgeries
• Medical conditions
• Medications
• Previous pelvic infections
• Sexual and reproductive history
• Lifestyle factors

The evaluation is then tailored to your individual situation.

What Tests Are Used for Female Infertility?

There is no single test that can diagnose every type of female infertility.

Depending on your symptoms and medical history, your doctor may recommend:

Blood Tests

Blood tests may assess hormones related to ovulation and reproductive function.

Depending on the situation, your doctor may check thyroid function, prolactin, ovarian reserve markers, or other hormones.

Ovulation Testing

If your periods are irregular, your doctor may evaluate whether and when ovulation is occurring.

Pelvic Ultrasound

A pelvic ultrasound can provide information about:

• The uterus
• Ovaries
• Endometrial lining
• Ovarian follicles
• Fibroids or other structural abnormalities

AMH Test

The AMH test is sometimes used to estimate ovarian reserve.

However, AMH should not be viewed as a simple “fertility test.” A woman's fertility depends on many factors, including age and egg quality.

HSG Test

A hysterosalpingogram (HSG) is an imaging test that can help determine whether the fallopian tubes are open and can also provide information about the shape of the uterine cavity.

Not every woman needs all of these tests. Your doctor will recommend investigations based on your individual circumstances.

How Is Female Infertility Treated?

Female infertility treatment depends on the underlying cause.

Treatment may involve lifestyle changes, medicines, surgery, IUI, IVF, or a combination of approaches.

Lifestyle Changes

A healthy lifestyle can support overall reproductive health.

Helpful habits include:

• Maintaining a healthy weight
• Eating a balanced and nutritious diet
• Exercising regularly
• Avoiding smoking and tobacco
• Limiting excessive alcohol consumption
• Getting adequate sleep
• Managing stress
• Keeping medical conditions under control

Lifestyle changes cannot correct every cause of infertility, but they can be an important part of fertility care.

Fertility Medicines

Fertility medicines may be prescribed when a woman has problems with ovulation.

These medicines may help stimulate ovulation or improve the timing and likelihood of conception.

Because fertility medicines can have side effects and may increase the risk of multiple pregnancy, they should be used under medical supervision.

Surgery for Female Infertility

In selected cases, surgery may help treat a condition that is affecting fertility.

Depending on the diagnosis, surgery may be considered for:

• Certain fibroids
• Endometriosis
• Polyps
• Some uterine abnormalities
• Selected cases of blocked fallopian tubes

Whether surgery is appropriate depends on the woman's age, fertility history, diagnosis, and other factors.

IUI for Female Infertility

Intrauterine insemination (IUI) is a fertility treatment in which prepared sperm is placed directly inside the uterus around the time of ovulation.

IUI may be considered in selected women with ovulation problems, unexplained infertility, or certain other fertility issues.

IVF for Female Infertility

In vitro fertilization (IVF) is an assisted reproductive treatment in which eggs are collected from the ovaries and fertilized with sperm in a laboratory.

An embryo is then transferred into the uterus.

IVF may be considered for certain women with:

• Blocked fallopian tubes
• Some forms of endometriosis
• Reduced ovarian reserve
• Certain male-factor fertility problems
• Unexplained infertility
• Previous unsuccessful fertility treatments

Your fertility specialist can help determine whether IVF is appropriate for your situation.

When Should You See a Doctor About Female Infertility?

You should consider speaking with a doctor if:

• You are under 35 and have been trying for 12 months without pregnancy.
• You are 35 or older and have been trying for 6 months without pregnancy.
• You are over 40 and want to become pregnant.
• Your periods are irregular or absent.
• You have PCOS or endometriosis.
• You have experienced pelvic infections.
• You have had previous reproductive surgery.
• You have concerns about your ovarian reserve or fertility.
• You have had repeated miscarriages.

You may not need to wait six or twelve months if there is already a known fertility concern.

Can Female Infertility Be Prevented?

Not all causes of female infertility can be prevented. Age-related changes in fertility, for example, are a natural part of reproductive biology.

However, you can take steps to protect your reproductive health:

• Avoid smoking and tobacco.
• Maintain a healthy weight.
• Practice safer sex to reduce the risk of sexually transmitted infections.
• Seek treatment for pelvic infections.
• Manage conditions such as diabetes and thyroid disorders.
• Discuss persistent menstrual problems with your doctor.
• Seek medical advice if you have symptoms of endometriosis or PCOS.

If you are planning to delay pregnancy, discussing your reproductive goals with a healthcare professional may also help you understand your options.

Does Female Infertility Mean You Cannot Get Pregnant?

No.

A diagnosis of female infertility does not automatically mean that you cannot become pregnant.

Some women conceive naturally after identifying and addressing factors that may be affecting fertility. Others may need medicines, surgery, IUI, IVF, or other fertility treatments.

Your chances of pregnancy depend on several factors, including:

• Age
• Egg quality
• Ovarian reserve
• Ovulation
• Fallopian tube health
• Uterine health
• Sperm health of the partner
• Duration of infertility
• Underlying medical conditions

This is why an individualized fertility assessment is so important.

Frequently Asked Questions About Female Infertility

What is the most common cause of female infertility?

There is no single cause that explains every case. Ovulation problems are an important cause, while PCOS, endometriosis, blocked fallopian tubes, age-related fertility decline, reduced ovarian reserve, and uterine problems may also contribute.

What are the signs of female infertility?

The main sign is difficulty becoming pregnant despite regular, unprotected sex. Irregular periods, absent periods, painful periods, pelvic pain, and other reproductive symptoms may indicate an underlying condition that can affect fertility.

Can PCOS cause infertility?

Yes. PCOS can interfere with regular ovulation and therefore make it harder to become pregnant. However, many women with PCOS can become pregnant naturally or with appropriate treatment.

Can endometriosis cause infertility?

Yes. Endometriosis can affect fertility through inflammation, scar tissue, adhesions, and changes involving the ovaries and fallopian tubes. However, many women with endometriosis are able to conceive.

Does age affect female fertility?

Yes. Female fertility generally decreases with age because the number and quality of eggs decline over time. The decline becomes more noticeable after the mid-30s.

What is the best test for female infertility?

There is no single “best” test. A fertility evaluation may include an assessment of ovulation, blood tests, pelvic ultrasound, ovarian reserve testing, and evaluation of the fallopian tubes. The appropriate tests depend on your individual circumstances.

Can female infertility be treated?

Yes. Depending on the cause, treatment may include lifestyle changes, fertility medicines, surgery, IUI, IVF, or other assisted reproductive techniques.

When should I see a doctor for female infertility?

If you are under 35, consider an evaluation after 12 months of trying to conceive. If you are 35 or older, consider seeking help after about 6 months. Earlier evaluation may be appropriate if you have irregular periods, PCOS, endometriosis, or another known fertility concern.

Takeaway

Female infertility can have many causes, but difficulty becoming pregnant does not mean that pregnancy is impossible.

Problems with ovulation, PCOS, endometriosis, blocked fallopian tubes, age-related fertility decline, reduced ovarian reserve, and uterine conditions can all affect fertility. A careful evaluation can help identify the possible cause and guide treatment.

If you have been trying to conceive without success, you don't have to keep wondering what is wrong. Talking to a gynecologist or fertility specialist can help you understand your fertility, identify possible problems, and explore the treatment options that are right for you.