Female Infertility

Medically reviewed

Medically reviewed by Lucia F., MD | Written by SheCares Editorial Team | Updated: Jun 18, 2020

Infertility presents a heavy burden on motherhood plans of 1 in every 10 women of reproductive age.

Those actively trying to get pregnant with no success often jump to drastic conclusions that their chances of having children are over, while in reality female infertility is treatable condition in the majority of cases.

Continue reading to familiarize yourself with infertility in women, including its signs and symptoms, main causes, and diagnostic tests so that you have all the necessary tools to effective seek treatment as you put concrete steps towards becoming a mother

Female infertility

About Infertility in Women

Infertility occurs when a woman is not able to get pregnant after a year of trying, or six months if she is at the age of 35 or older. It also includes when a woman cannot carry a pregnancy to full term

Although female fertility naturally ends with menopause due to a normal decline of reproductive hormones, conception problems might occur earlier on in a woman's ripe reproductive years. As such, infertility touches the lives of at least 10% of women of childbearing age.

Signs & Symptoms of Female Infertility

Female infertility signs and symptoms

Symptoms of Female Infertility

In most cases of female infertility, women do not experience clear symptoms.

However, there might be symptoms characteristic to other medical conditions known to cause infertility in women, including:

Signs of Female Infertility

In contrary to symptoms reported by women themselves, infertility signs are measurable criteria that are usually assessed by a physician through a variety of diagnostic tools.

  • Imbalance of reproductive hormones
  • Abnormal thyroid hormones
  • Positive STD test
  • Low antral follicle count
  • Blocked fallopian tubes
  • Uterine scarring

Causes of Female Infertility

Causes of female infertility

Hormonal Imbalance

The main cause of infertility in women is hormonal imbalance, particularly estrogen and progesterone. Because the functioning of a healthy reproductive system is governed by hormones, their imbalance have a direct effect on a woman's ovulation. With ovulation problems, the chance of pregnancy is reduced.

Hormonal imbalance leading to abnormal ovulation can have the following causes:

  • Polycystic ovary syndrome (PCOS)
  • Hypothalamic or pituitary dysfunction
  • Premature ovarian insufficiency
  • Prolactinemia
  • Low ovarian reserve

Damage or Blockage in the Reproductive Tract

Besides hormonal imbalance, infertility in women might also occur due to damaged or blocked reproductive organs, namely the cervix, fallopian tubes, or uterus. When the tubes are not permeable to sperm, conception cannot occur, a condition called tubal infertility. Similarly, if the uterus is scarred, the fertilized egg cannot implant itself in its wall.

Blockage or scarring in the fallopian tubes or uterus can have the following causes:

  • Endometriosis
  • Pelvic inflammatory disease
  • Previous ectopic pregnancy
  • Pelvic tuberculosis
  • Uterine fibroids
  • Sexually transmitted diseases (STDs)
  • Abnormal uterine anatomy
  • Cervical stenosis

Unexplained Female Infertility

Although in the majority of female infertility cases, the underlying cause can be determined, about 10% remain without a clearly identified cause. It is believed that unexplained infertility can be due to a combination of some undiagnosed health conditions, certain lifestyle practices, and male partner factors.

Risk Factors of Female Infertility

Various factors have been associated with increasing the risk of infertility directly or indirectly by elevating the likelihood of developing conditions known to diminish a woman's fertility. They include the following:

  • Age (above 35)
  • Prolonged high stress
  • Strenuous exercise
  • Obesity (BMI of 30 kg/m2 or above)
  • Underweight (BMI 18.5 kg/m2 or below)
  • Eating disorders (anorexia, bulimia, binge eating)
  • Smoking and excessive alcohol use

Female Infertility Tests

Female infertility tests

After not being able to get pregnant after 12 months, a woman is typically advised to undergo various fertility tests to pinpoint the underlying cause of infertility. Because fertility at 35 diminishes at more rapid rates, women in their mid-30s should get tested after six months.

Although the suspected infertility in women will most commonly be evaluated with medical tests, a woman also has various at-home tools to assess her fertility.

Home Female Infertility Tests

Since abnormal ovulation is the leading infertility, all female infertility tests taken at home are designed to determine whether a woman's ovulation is occurring timely.

These aforementioned at-home fertility tests are important as they can give the doctors view of a woman's menstrual and ovulatory patterns and help them determine the cause of infertility more efficiently. 

Medical Female Infertility Tests

Proper medical workup for infertility in women starts from the least invasive tests and progresses only if the underlying causes has not been relieved yet.

  • Physical exam, which always precedes any infertility tests, is when a woman's overall health is assessed as well as medical and sexual history is discussed, her medications are reviewed, and menstrual patterns are taken note of.

  • Pap smear is the most standard gynecological test initiating infertility evaluations. It can give view of potential cervical problems and ongoing STDs.

  • Blood tests are used to check for hormonal imbalance, possible endocrine disorders, undiagnosed infections, and the state of ovarian reserve, all potential causes of female infertility.

  • Diagnostic examinations usually start with a transvaginal ultrasound to count ovarian eggs and rule our anatomical problems within the reproductive tract. More advanced diagnostic tests, such as hysteroscopy or biopsy, are performed as necessary.

  • Genetic testing for possible chromosomal defects is performed when all female infertility tests thus far have failed to provide clues.

Female Infertility Treatments

Female infertility treatment

Female infertility treatment depends on the exact cause and other individual characteristics, such as a woman's age and overall health status. Because fertility issues are mainly caused by hormonal balance, treatment options are oriented towards restoring proper hormone levels, thus improving or inducing ovulation.

Women struggling with infertility can approach its treatment in three ways: (1) lifestyle adjustments, (2) alternative medicine, or (3) conventional medicine.


Lifestyle Adjustments

For women planning to conceive, maintaining healthy lifestyle habits is of essence not only for the sake of their fertility, but the safety of their pregnancies and the health of their future babies. They might include following a well-balanced fertility diet, such as one that is rich in phytoestrogens and full-fat dairy; keeping up with fertility exercise to enhance hormonal balance and maintain a healthy weight; and considering alternative therapies for fertility, such as stress-reduction techniques.


Alternative Medicine

Fertility can also be restored naturally with the help of various fertility supplements and vitamins, including herbal phytoestrogenic supplements, such as red clover, black cohosh, or ginseng; hormone-regulating supplements, such Macafem; or other supplements, like folic acid, lipoic acid, omega-3 fatty acids, or coenzyme Q10.


Conventional Medicine

Medications to treat infertility in women most commonly include fertility drugs and injections, which stimulate or regulate ovulation. Other medications might be used to manage ongoing health conditions contributing to infertility, like thyroid disorders or STDs. Fertility surgery is the usually the last resort in treating female infertility and can consist of removing tubal blockages or uterine scarring as well as procedures to induce ovulation, like ovarian drilling, among others.

Reproductive Assistance for Female Infertility

Women whose infertility could not be treated with the aforementioned treatments can achieve pregnancy with the help of assisted reproductive technologies (ARTs). Women most commonly choose between an artificial insemination (AI) or in vitro fertilization (IVF). The exact success rate of ARTs vary from woman to woman.

Key Takeaways

Women know that their chances of becoming a mother are limited by their age; however, when their fertility is suddenly reduced sooner while they are still in their reproductive years, it understandably creates anxiety and despair. Female infertility affects one in every six women between the ages of 15 and 44, heavily compromising their chances of having children unless prompt treatment is sought after. The main underlying cause is hormonal balance, which disrupts ovulation and the whole functioning of the reproductive system. Fortunately, infertility in women can be successfully resolved through lifestyle changes, including fertility-boosting diet and exercise; vitamins and herbal supplements; and conventional medications and surgery.