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Infertility in Women

Infertility in women facts

  • Female infertility is diagnosed when a woman is found to be the sole or partial cause of a couple’s inability to conceive after a year of trying through unprotected sex, or after six months for women over 35.
  • About 15% of couples in the United States will struggle with fertility problems, and about one-third of these cases are due solely to female infertility and another third involves both female and male infertility.
  • Common causes of infertility in women include age, ovulation disorders, structural complications or unexplained infertility, meaning no cause can be identified.
  • Lifestyle factors like obesity and smoking can also contribute to infertility in women.
  • Treatments for women with infertility include medications to assist in ovulation, surgery, intrauterine insemination (IUI), in vitro fertilization (IVF) and other assisted reproduction treatments.


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What is female infertility?

Female infertility is when a woman is found to be the cause or part of the cause for a couple’s inability to get pregnant after regularly having unprotected intercourse after a certain period of time.

For women under age 35, infertility is diagnosed after a year of not conceiving despite unprotected intercourse. Women age 35 and older are considered infertile after six months of unprotected intercourse because female fertility naturally declines more rapidly in the mid-30s.

The American Society for Reproductive Medicine (ASRM) estimates that about 15% of couples experience infertility. Roughly one-third of these cases are due to only female factors. Another third are caused by male factors and the final third are due to a combination of male and female infertility.

Female infertility symptoms

Often infertility goes unnoticed until a woman begins trying to conceive. There may be no other symptoms. However, some common signs of infertility in women include:

  • Irregular or no menstruation.
  • Menstrual cycles that last longer than 35 days or less than 21 days.
  • Pelvic inflammatory disease, endometriosis or painful menstruation.
  • Recurrent miscarriages.

Secondary infertility in women

If a woman or couple has one successful pregnancy, they can still experience secondary infertility, meaning the inability to get pregnant again after a year of trying.

For the most part, issues that can cause infertility can also cause secondary infertility. These can be due to the female, male or both.

Causes of infertility in women

The three main complications that can cause infertility in women are ovulation problems, structural issues and unexplained infertility.

Ovulation disorders

ASRM estimates that 40% of cases of female infertility are caused by ovulatory dysfunction or disorders.

In order to conceive, a woman’s ovary needs to release a mature egg that can become fertilized by sperm. This natural process can be interrupted by ovulation disorders caused by problems in the ovaries or with levels of reproductive hormones. There are also some cases when the cause of ovulation dysfunction is not known.

Common ovulation disorders include the following.

  • Polycystic ovary syndrome, or PCOS, can cause a number of symptoms, which impact fertility. Most often PCOS presents as irregular or absent menstruation, ovarian cysts and hormonal problems like acne and/or unwanted hair growth.
  • Hypothalamic dysfunction, also known as hypothalamic amenorrhea, is caused by a problem within the hypothalamus in the brain. The brain stops signaling the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which impairs fertility. This can be brought on by significant weight loss and excess stress, excess exercise and other factors.
  • Premature ovarian failure causes the ovaries to stop producing estrogen and brings on the early onset of menopause. Women with autoimmune disorders, or who have undergone chemotherapy or radiation, or have a connected genetic disorder may experience premature ovarian failure.
  • Hormone complications such as the excess of prolactin, which reduces estrogen levels, or thyroid dysfunction can cause infertility in women.

Structural issues in a woman’s reproductive system

The most common types of structural infertility involve issues with the fallopian tubes or uterus. Damaged or blocked fallopian tubes can prevent the sperm from meeting the egg to fertilize or prevent the fertilized egg from reaching the uterus.

  • Fallopian tube damage may be caused by infection, unknown factors, or previous surgery in the abdomen or pelvic areas. This surgery or damage may be linked to a previous ectopic pregnancy.
  • Endometriosis can impair female fertility by causing the tissue lining the womb to spread beyond the uterus creating structural damage. According to the American College of Obstetricians and Gynecologists, this condition affects 1 in 10 women of reproductive age.
  • Pelvic inflammatory disease (PID) can build up scar tissue and create structural complications. PID is often linked to sexually transmitted diseases (STDs) or infections (STIs).
  • Fibroids, cysts and uterine abnormalities, such as an abnormal shaped uterus, can impact a woman’s fertility by interfering with successful embryo implantation in the womb.
  • Previous surgery such as appendectomy or pelvic surgery can cause scar tissue that can block the fallopian tubes.

Unexplained infertility

This diagnosis actually means everything reproductively appears to be working as normal but available tests and examinations do not pinpoint a cause of infertility in the woman or partner. Unexplained infertility is one of the more frustrating causes of fertility problems as it does not provide a clear diagnosis. However, unexplained infertility is thought to be the cause of infertility in 1 in 5 couples, according to RESOLVE, the National Infertility Association.

Although there may still be an underlying issue that isn’t easily identified, unexplained infertility is often successfully treated with reproductive assistance.

Recurrent miscarriage

Defined as two or more consecutive miscarriages, recurrent miscarriage is a form of infertility that a fertility specialist should evaluate. The cause of a recurrent miscarriage, also called recurrent pregnancy loss, can be due to genetics, abnormal structure, hormone imbalance, infection and other causes.

Infertility risk factors for women

Advanced maternal age & diminished ovarian reserve

Statistics show that about one-third of couples in which the woman is older than 35 will experience infertility.

As a woman ages, her fertility starts to decline as a result of her finite number of eggs in the ovaries diminishing over time. In addition, the eggs that do remain lose quality with age, making egg fertilization for pregnancy more difficult. Having fewer genetically healthy eggs available for ovulation also leads to a higher risk of miscarriage after a low-quality egg is fertilized to become an embryo.

A woman’s egg quantity and quality begin to decline in her mid-30s. This deterioration accelerates rapidly in her late-30s, making conception more challenging. When this loss of egg quality and quantity reaches a critical point, it is known as diminished ovarian reserve.

Smoking & female infertility

Smoking and infertility go hand in hand. In fact, infertility rates among smokers are double for both men and women. And this number corresponds directly to how many cigarettes a patient smokes each day.

Women experience even more fertility-related issues than men. The specific effects include:

  • Egg quality and quantity decrease more quickly.
  • Fertility treatments are less effective.
  • Miscarriage occurs at a higher rate.
  • The woman is at greater risk for ectopic pregnancy and preterm labor.
  • Babies are at higher risk for birth defects and medical problems.

Stress & infertility in women

Researchers have been unable to prove that stress causes infertility. However, everyone in the field of reproductive medicine agrees that infertility can cause stress, and sometimes even depression. Stress and depression can have an indirect effect on reproduction by dampening one’s desire to have sex, thereby limiting the chances for pregnancy.

This information will come as no surprise to fertility patients. After all, infertility impacts all areas of life, including work, relationships, health and finances.

A woman’s weight

While many women who are underweight or overweight have no trouble getting pregnant, weight and infertility issues can occur together. Some women may experience ovulation problems when their body mass index (BMI) is too high or too low.

  • Underweight: Women who have a BMI of less than 19 are considered underweight, which can result in irregular menstrual cycles. Some women may stop ovulating.
  • Overweight & obese: Women who have a BMI between 25 and 29 are considered overweight, and women who have a BMI greater than 30 are considered obese. Women in these categories can also experience irregular menstrual cycles and irregular ovulation, as well as other disorders that can impact pregnancy, including diabetes, insulin resistance and thyroid disease.
  • Women who are obese have lower pregnancy rates and higher rates of miscarriage, pregnancy complications and birth defects in their babies.

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Fertility tests for women

The first step in the fertility testing process is a conversation with a fertility specialist about health history, sexual history and reproductive goals, as well as any conditions or symptoms that may impact fertility. After this conversation, a fertility specialist will perform a physical examination to determine if there are any obvious structural issues and to evaluate the woman’s overall health.

Once these steps are complete, additional testing may include

  • Checking ovarian reserve (quantity of eggs remaining in ovaries).
  • Inspecting the ovaries, fallopian tubes and uterine cavity to check for structural or anatomical issues via various imaging techniques and procedures.
  • Testing for uterine abnormalities like polyps or fibroids via a transvaginal ultrasound or office hysteroscopy.
  • Additional visual diagnostic to check for external or internal issues.

Female infertility treatment

Effective infertility treatment will vary based on a woman’s age, health history, preferences and more details that a fertility specialist will discuss with each patient.

Less aggressive, but still successful, fertility treatment options

  • For some women, lifestyle changes such as maintaining a healthy weight, quitting smoking or decreasing excessive exercise, can improve fertility.
  • Using ovulation induction medication can stimulate the ovaries to release eggs, which can help address ovulation disorders that may prevent this process.
  • Intrauterine insemination, or IUI, can greatly improve the chances of conceiving by directly inserting sperm into the uterus.
  • Minimally invasive surgery can be used to address any structural problems such as fibroids, which may be interfering with a woman’s fertility. This surgery can be performed at the same time as a diagnostic laparoscopy that identifies such issues.

More aggressive treatments for female infertility

  • In vitro fertilization (IVF) utilizes advanced techniques to fertilize an egg with sperm in a laboratory setting. The fertilized egg, now an embryo, is then implanted into the uterus.
  • In order to use the best possible embryos with the IVF process, a fertility specialist may use preimplantation genetic testing (PGT). This testing evaluates the embryos for genetic conditions, disorders and other factors that may prohibit it from successfully implanting or the pregnancy continuing through birth.
  • Women who cannot use their own eggs to achieve a pregnancy may decide to use donor eggs or embryos.
  • For those who cannot carry a pregnancy, whether due to problems in the uterus or health problems, a woman can use a gestational carrier (a woman who carries another person’s pregnancy using the intended mother’s eggs, or donor eggs, and the male’s sperm).


More patient resources

For additional information, we recommend the educational materials on infertility provided by the American Society for Reproductive Medicine (ASRM). Some of these are listed below.