Understanding why conception isn’t happening as expected can be an emotional and challenging experience. That’s why fertility workups are so important—they help uncover the underlying causes of infertility and guide the next steps toward building a family.
This guide outlines the most common causes of female infertility that may be identified during a fertility workup. With this knowledge, you’ll feel more prepared and informed when discussing your results and treatment options with your fertility specialist.
1. Ovulatory Disorders
Ovulation issues are one of the most frequent causes of female infertility.
Common Conditions:
- Polycystic Ovary Syndrome (PCOS): A hormonal imbalance that interferes with ovulation. Common symptoms include irregular periods, acne, and excess hair growth.
- Hypothalamic Amenorrhea: Caused by stress, weight loss, or excessive exercise, this condition results in the brain not signaling the ovaries to ovulate.
- Premature Ovarian Insufficiency (POI): The ovaries stop functioning normally before age 40, leading to irregular or absent ovulation.
- Thyroid Dysfunction: Both hypothyroidism and hyperthyroidism can disrupt menstrual cycles and prevent ovulation.
- Hyperprolactinemia: Elevated prolactin levels can interfere with the hormones responsible for ovulation.
How It’s Diagnosed:
- Hormone blood tests (FSH, LH, Estradiol, AMH, TSH, Prolactin)
- Menstrual cycle history
- Ultrasound of ovaries
2. Tubal Factor Infertility
Blocked, damaged, or scarred fallopian tubes can prevent the egg and sperm from meeting.
Causes:
- Pelvic Inflammatory Disease (PID): Often the result of untreated sexually transmitted infections (e.g., chlamydia, gonorrhea).
- Endometriosis: Can cause scarring and adhesions around the fallopian tubes.
- Previous Tubal Surgery or Ectopic Pregnancy: May lead to scarring or obstruction.
- Hydrosalpinx: A blocked fallopian tube filled with fluid, which can be toxic to embryos.
How It’s Diagnosed:
- Hysterosalpingogram (HSG): An X-ray with contrast dye to check tubal patency.
- Sonohysterogram or Laparoscopy: May be used for further evaluation.
3. Uterine Abnormalities
The uterus must be structurally healthy for implantation and pregnancy to occur. Abnormalities can interfere with embryo implantation or cause miscarriages.
Common Uterine Issues:
- Fibroids (Leiomyomas): Benign tumors in the uterine wall. Submucosal fibroids can distort the uterine cavity and interfere with implantation.
- Polyps: Small, benign growths of the endometrial lining that may impede implantation.
- Congenital Abnormalities: Such as a septate uterus (a wall dividing the uterus), which can lead to recurrent pregnancy loss.
- Intrauterine Adhesions (Asherman’s Syndrome): Scar tissue inside the uterus, often due to surgery or infection.
How It’s Diagnosed:
- Transvaginal ultrasound
- Sonohysterogram (saline-infused ultrasound)
- Hysteroscopy (camera-guided evaluation inside the uterus)
4. Endometriosis
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus—on the ovaries, fallopian tubes, or pelvic lining. It can lead to inflammation, scar tissue, and adhesions, affecting ovulation, tubal function, and implantation.
Symptoms:
- Painful periods
- Pain during sex
- Chronic pelvic pain
- Infertility (even in mild or asymptomatic cases)
How It’s Diagnosed:
- Clinical history and symptoms
- Transvaginal ultrasound (to detect ovarian endometriomas)
- Diagnostic laparoscopy (the gold standard for diagnosis)
5. Diminished Ovarian Reserve (DOR)
DOR refers to a lower-than-normal quantity or quality of eggs. It may occur naturally with age or due to other factors.
Causes:
- Age (especially over 35)
- Genetic factors
- Autoimmune conditions
- Prior ovarian surgery
- Chemotherapy or radiation
How It’s Diagnosed:
- AMH (Anti-Müllerian Hormone): Low levels suggest fewer eggs.
- FSH and Estradiol on day 3 of the menstrual cycle
- Antral Follicle Count via ultrasound
6. Unexplained Infertility
In some cases, all test results come back normal, but conception still doesn’t happen.
What It Means:
- Roughly 10–20% of infertility cases fall into this category.
- It doesn’t mean nothing is wrong—just that no specific issue has been identified with current testing methods.
Next Steps:
- Lifestyle changes
- Fertility treatments like IUI (intrauterine insemination) or IVF (in vitro fertilization)
- Further or more advanced testing
7. Lifestyle and Environmental Factors
While not always the primary cause, certain lifestyle factors can significantly impact fertility.
Influential Factors:
- Obesity or being underweight
- Smoking (including secondhand smoke)
- Excessive alcohol or caffeine intake
- High levels of stress
- Environmental toxins (e.g., pesticides, plastics)
- Excessive exercise
How It’s Addressed:
- Counseling on lifestyle modifications
- Nutritional guidance
- Stress reduction strategies
When to See a Fertility Specialist
You should consider a fertility evaluation if:
- You’re under 35 and have tried to conceive for over 12 months
- You’re over 35 and have tried for 6 months or more
- You have a known reproductive issue (e.g., PCOS, endometriosis, irregular periods)
- You’ve experienced multiple miscarriages
- You have a history of pelvic infections or surgeries
Final Thoughts
Identifying the cause of infertility is the first step toward effective treatment and, ultimately, achieving pregnancy. While a diagnosis can feel daunting, it also opens the door to targeted solutions and renewed hope. With today’s advanced fertility testing and treatments, many causes of infertility are manageable—and often treatable.
You’re not alone on this journey. Your fertility team is there to support you with compassion, expertise, and personalized care every step of the way.
