Female infertility: Signs & how to know if you’re infertile

What is female infertility?

Infertility can feel like quite a loaded or stigmatized term, but it’s actually got a clear medical definition. Female infertility is classified as the inability to achieve pregnancy after 12 months of regular, unprotected sexual intercourse. Based on your medical history and physical findings, earlier evaluation and treatment may be offered to women who are over 35 years old, who have been TTC for 6 months [1].

If you’ve been struggling to conceive, you’re not alone. Infertility is very common — approximately 15% of couples worldwide experience infertility, and female infertility accounts for approximately 50% of this. Female infertility is estimated to impact approximately 9% of women in the United States. Male factors make up approximately 40%, and 10% is due to combined factors; where both male and female factors, such as low sperm count and low egg supply, occur at the same time [2].

What causes female infertility?

There are many potential causes of infertility in women. One of the major causes is problems with ovulation [2]. In some cases, such problems prevent an egg from being released at all, while others prevent an egg from being regularly released as it should each cycle. There can also be blockages of the fallopian tubes that prevent fertilization from occuring. Some of the conditions underlying these problems include:

• Polycystic Metabolic ovarian syndrome (PMOS): formerly known as PCOS – Those with PMOS may experience irregular cycles, which can also be anovulatory (without ovulation) [3].

• Thyroid problems:  having an over or underactive thyroid gland can prevent ovulation from occurring [4].

• Premature ovarian failure:  when your ovaries stop working normally (ie, reduced egg count and release, and lower estrogen levels) before the age of 40 [5].

• Problems which impact the fallopian tubes: these account for approximately 20-35% of female infertility, and include things like pelvic inflammatory disease (PID), endometriosis, or previous pelvic surgeries [2].

If you have any of the conditions above and are worried about your chances of conceiving, we recommend seeking advice from your doctor early on, in case there are specific treatments that may support you on your TTC journey, and improve your chances of conceiving.

Signs of infertility in women

The main sign of infertility in women is the inability to get pregnant. Typically, a diagnosis of infertility is given after TTC for a specific amount of time. The time at which this is diagnosed differs slightly depending on how old you are. For those who are 35 years old or younger, this will be one year of regular unprotected sex. If you’re older than 35, this will typically be after 6 months of regular unprotected sex [6].

Though having conditions like those listed above, or irregular cycles, can contribute to infertility, it is important to remember that having these does not necessarily mean that you are infertile, or will never be able to have children. 

How does age impact female infertility?

Age is one of the most important factors impacting female infertility. As you age, the quality and quantity of your eggs decline. On average, by  age 30, this decline begins, and by 35 years old, it happens much more rapidly [7]. 

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

To find out the underlying cause of female infertility, your healthcare provider will start by asking you some questions and may run some tests. In a consultation, they may ask you about your pregnancy history, length of time trying to conceive, how often you’re having sex, length of time since stopping contraception, and you and your partner’s lifestyle and medical history [8].

Testing may include:

• Physical exam:  To ensure that you’re generally healthy, your clinician might do a physical test to check your weight, or an internal pelvic exam to check for any infection, polyps or tenderness.

• Blood test: By testing your hormone levels, including progesterone, the clinician will try to understand whether you’re regularly ovulating. 

• Ultrasound: Certain conditions like endometriosis and fibroids can impact the reproductive tract and your chances of getting pregnant. An ultrasound can be performed to see if there is anything blocking your fallopian tubes, which would prevent the egg cell from moving to the fallopian tubes to be fertilized and implanted. There are different types of ultrasounds–you may be offered a sonohysterogram, which involves injecting a saline (salt water) solution into the uterus to identify things like polyps or fibroids. If there are any obstructions, or other findings that might be imparting your fertility, your doctor may suggest surgery or further testing. 

• Chlamydia test: Chlamydia can impact fertility. To test for chlamydia, a swab or urine test may be given. Antibiotics will be given to resolve the STI, if you do have it.

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Your doctor may also recommend testing for your partner to understand if there are any underlying conditions, or factors impacting sperm count or quality, that may need to be addressed [8].

How is female infertility treated?

Infertility may be treated in different and sometimes multiple ways, depending on the underlying cause. This may include:

Lifestyle changes: Maintaining a healthy weight and diet, and reducing or stopping smoking and drinking alcohol are recommended to increase your chances of getting pregnant. These changes can also be made before TTC.

Surgery: If the identified issue is structural and involves the fallopian tubes, surgery may be performed to clear them. Further, if you have endometriosis, fibroids or polyps, surgery may be offered to treat these conditions.

Medication: If you are not ovulating, medications like clomiphene citrate and aromatase inhibitors may be offered to help stimulate this.

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When to see a doctor

Guidance suggests that if you’re under 35 and you have been trying to conceive for a year, are over 35 and have been trying for 6 months, or are 40+ and thinking about having a baby, it is a good idea to speak with your doctor. If you have a condition that is known to impact your fertility, such as endometriosis, PMOS (formerly known as PCOS), or a thyroid condition, it’s a good idea to speak with your doctor earlier on in your TTC journey.

Know your body better with Natural Cycles.

Whether you’re just starting your TTC journey or have been trying for a while, Natural Cycles is here to help you along the way. NC° Plan Pregnancy helps you find fertile days and pinpoint if and when you ovulate so you know the best time to have sex to maximize chances of pregnancy. The app is packed full of tailored insights and also provides a helpful Cycle Report, which you can download and bring to your doctor’s appointment to inform any conversations about fertility. Find out how Natural Cycles can support you today.