Female Infertility

What is female infertility?

Infertility is a disease that makes a person unable to get pregnant. For people assigned female at birth (AFAB), an infertility diagnosis comes after:

• Six months of trying to get pregnant if you’re older than 35.
• One year of trying to get pregnant if you’re younger than 35.

Trying to get pregnant means you’re regularly having sex without birth control. Some people receive a diagnosis sooner if they have a medical condition or uterine factor infertility.

Causes of infertility can be due to either partner. In fact, infertility occurs due to a problem with the male reproductive system just as frequently as it occurs due to a problem with the female reproductive system.

Infertility in women can result from age, hormone conditions, medical conditions, and lifestyle or environmental factors.

When the cause of infertility is thought to come from the person with a uterus, healthcare professionals consider it female infertility or “female factor” infertility.

What are the types of female infertility?

Infertility can be either primary or secondary:

Primary infertility means you’ve never been pregnant and can’t get pregnant after six months (older than 35) or one year (younger than 35) of trying.

Secondary infertility occurs when you can’t get pregnant again after having at least one successful pregnancy and birth.

How common is female infertility?

Infertility is a common disease. At least 10% of women and people assigned female at birth deal with infertility of some kind. The chances of infertility increase with age.

What are the signs of infertility in women?

The most common sign of infertility is being unable to get pregnant despite having regular, unprotected sex. Other signs may include absent or irregular periods.

What causes female infertility?

There are many possible causes of infertility. However, it can be difficult to pinpoint the exact cause, and some couples have unexplained infertility. Some possible causes of female infertility can include:

• Problems with your uterus: This includes uterine polyps, fibroids or adhesions (scarring) inside the cavity of your uterus. Polyps and fibroids can form on their own at any time. Adhesions can form after a surgery like a dilation and curettage (D&C).
• Problems with your fallopian tubes: The most common cause of “tubal factor” infertility is pelvic inflammatory disease (PID). Untreated chlamydia and gonorrhea are common causes of PID. Endometriosis can also cause scarring of your fallopian tubes.
• Problems with ovulation: There are many reasons why a person may not ovulate (release an egg) regularly. Hormonal imbalances, an eating disorder, substance use disorder, thyroid conditions, severe stress and pituitary tumors are all examples of things that can affect ovulation.
• Problems with egg count and quality: You’re born with all the eggs you’ll ever have, and this supply can run out early, before the natural age of menopause (around 51). In addition, some eggs will have the wrong number of chromosomes and be unable to fertilize and grow into a healthy fetus.

What is the leading cause of female infertility?

Most cases of infertility in people with a uterus involve problems with producing and releasing eggs (ovulation). It can be due to a condition like polycystic ovary syndrome (PCOS) or other conditions like primary ovarian insufficiency (POI), a condition in which an extremely low egg supply makes your ovaries stop functioning before the age of 40.

What are risk factors for infertility?

Many factors can increase your risk for infertility. General health conditions, genetic (inherited) traits, lifestyle choices and age can all contribute to infertility. Specific factors can include:

• Age. Generally, fertility begins to decline in your 30s.
• Hormone issues that prevent ovulation.
• Abnormal menstrual cycle.
• Obesity.
• Having underweight.
• Overexercise or intense exercise.
• Endometriosis.
• Structural problems (physical problems with your fallopian tubes, uterus or ovaries).
• Uterine fibroids.
• Ovarian cysts.
• Tumors.
• Autoimmune disorders (lupus, rheumatoid arthritis, Hashimoto’s disease).
• Sexually transmitted infections (STIs) causing pelvic inflammatory disease.
• Polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder that can cause infertility.
• Primary ovary insufficiency (POI).
• Excessive substance use (heavy drinking or misuse of drugs).
• Smoking.
• A past ectopic pregnancy.

How does age impact female infertility?

Your chances of becoming pregnant decrease with age. Research shows that age is becoming a more common factor in infertility because many couples are waiting to have children until their 30s or 40s. People over age 35 have a higher risk of having fertility issues. The reasons for this include:

• Overall number of eggs is lower.
• More eggs have an abnormal number of chromosomes.
• An increased risk of other health conditions. The older a person gets, the greater their chance of acquiring a health condition.

How do you know if you’re fertile?

Only a healthcare provider can make an infertility diagnosis. If you’re having difficulties getting pregnant or think you may have infertility, make an appointment with a fertility specialist. There are tests that can help them make a diagnosis. Try not to worry. Many people go on to have successful pregnancies with treatment.

What will my healthcare provider ask during an appointment to diagnose female infertility?

Your healthcare provider will need to know your complete medical history, along with information about:

• Your menstrual periods (how long they last, the amount of bleeding, etc.).
• Any past pregnancies, including miscarriages.
• Pelvic pain.
• Unusual vaginal bleeding or discharge.
• Past abdominal or pelvic surgeries.
• Previous uterine or vaginal infections, including sexually transmitted infections (STIs).

What tests will my healthcare provider run to diagnose female infertility?

Most tests happen in your healthcare provider’s office. These tests may include:

• A physical exam.
• A pelvic exam.
• A pelvic ultrasound.

Other tests may need to be done in a lab. These tests can include:

• Blood tests: The type of blood test will depend on your health history and what condition your provider is testing for. Examples of blood tests include thyroid function tests, tests to check levels of hormones involved in ovulation and menstruation, and tests of ovarian reserve (egg supply). Diminished ovarian reserve is when you have fewer eggs left in your ovaries compared to others your age.
• X-ray hysterosalpingogram (HSG): Your provider injects contrast dye through your cervix and into your uterine cavity and then watches how the dye moves through your fallopian tube with an X-ray. This test checks for blockages.
• Laparoscopy: In this test, your provider inserts a small monitoring instrument called a laparoscope into your abdomen to look at the organs.
• Transvaginal ultrasound: Unlike an abdominal ultrasound (where the probe is on your belly), a transvaginal ultrasound involves your provider inserting a wand into your vagina.
• Saline sonohysterogram (SIS): This test looks at the lining of your uterus to assess for polyps, fibroids or other structural abnormalities. Your provider fills your uterus with saline, which allows them to have a better view of your uterine cavity during a transvaginal ultrasound. SIS can also sometimes be used to test if the fallopian tubes are open.
• Hysteroscopy: In this test, your provider inserts a hysteroscope (a thin device with a camera on it) into your vagina and through your cervix. This allows your provider to better see inside your uterus.

How is female infertility treated?

Once your healthcare provider diagnoses infertility and determines a cause, they’ll suggest possible treatment options. Treatment options depend on the cause. Some of the treatments are:

• Surgery: When a structural issue, blockage or scarring is the cause of infertility, your provider may be able to treat it with surgery.
• Fertility medication: Taking fertility medications can help with hormonal imbalances or ovulation disorders. Certain hormonal medications can also stimulate ovulation and help you to release an egg.
• Antibiotics: Antibiotics can help remove an infection from your reproductive organs.
• Fertility awareness: Tracking ovulation by assessing your cervical mucus or measuring your basal body temperature are other ways your provider may assess your fertility. Many trying to conceive also use home ovulation predictor kits and smartphone apps that track their menstrual cycle to determine the best time at attempting to conceive.

Some people will require special treatments like intrauterine insemination (IUI) or assisted reproductive technologies (ART) like in vitro fertilization (IVF). Adoption and gestational surrogacy may also be options for people with infertility who wish to start a family.

Complications of treatment

Complications of fertility treatment mainly involve complications with using medications to stimulate ovulation. These complications include:

• Higher chance of becoming pregnant with multiples (twins, triplets, etc.).
• Ovarian hyperstimulation syndrome (OHSS). A condition that causes painful and swollen ovaries as a result of fertility medications.

Can female infertility be prevented?

You can’t predict or prevent most types of female infertility. However, you may be able to control some of the risk factors that contribute to infertility with lifestyle modifications. Examples include:

• Reducing alcohol consumption.
• Quitting smoking.
• Maintaining a healthy weight for you.
• Developing a good exercise routine.
• Eating a diet rich in fruits and vegetables.
• Trying to sleep at least seven hours per night.

It’s important to regularly visit your healthcare provider and discuss any other risks you may have for infertility. You should also schedule annual checkups with a gynecologist once you begin having sex, so your healthcare provider can better detect conditions that may affect your future fertility.

What can I expect if I have infertility?

The outlook for female infertility depends greatly on the individual and the underlying cause of infertility. The outcome is very positive when the cause of infertility is due to ovulatory disorders or structural abnormalities where treatment is possible. Some reproductive conditions, like uterine factor infertility, are harder to treat.

Talk to your healthcare provide about your family history, risk factors and underlying medical issues to learn more about your chances of a successful pregnancy.

When should I see my healthcare provider about female infertility?

If you have regular intercourse and predictable menstrual cycles, you should see your healthcare provider after 12 months of trying to conceive, or six months if you’re over the age of 35. They can help determine why getting pregnant is difficult and recommend treatment to help you conceive.

What makes a woman more fertile?

Many factors that affect fertility, like medical conditions and congenital anomalies (things you’re born with), are beyond your control. Lifestyle factors, however, are within your control. Taking some of the following steps can help promote fertility:

• Prevent STIs by using a condom during sexual activities.
• Get tested regularly for STIs like gonorrhea and chlamydia.
• Avoid exposure to chemicals, pesticides and other pollutants.

It’s also important to visit your healthcare provider annually once you become sexually active. Regular visits and preventive screenings are the best ways to take control of your sexual health.

A note from Cleveland Clinic

Infertility can be incredibly stressful. If you’ve been trying to get pregnant for 12 months without success — or six months if you’re over the age of 35 — reach out to your healthcare provider. A healthcare provider can help determine the cause and a treatment plan. Try to stay positive. Most people are able to conceive with the right treatment.