Common Fertility Issues in Women and How to Address Them

What Is Female Infertility?

Female infertility refers to the inability to conceive after one year of regular, unprotected intercourse for women under 35, or after six months for women 35 or older. It is a multifaceted issue influenced by age, hormone levels, anatomy, medical history, and lifestyle factors. It’s also more common than many realize, and often misunderstood.

Infertility doesn't always mean a woman cannot conceive at all—it may mean that conception takes longer, happens with assistance, or requires identifying and addressing a specific underlying issue. Many individuals affected by infertility go on to have healthy pregnancies with the right support and care.

What Are the Most Common Causes of Female Fertility Issues?

Ovulatory Disorders

When the ovaries fail to release an egg regularly or predictably, conception is less likely. These issues are often related to hormonal imbalances. Examples include:

• Polycystic ovary syndrome (PCOS)
• Hypothalamic amenorrhea
• Premature ovarian insufficiency
• Thyroid disorders

Ovulatory problems are a leading cause of infertility and often respond well to treatment once diagnosed.

Fallopian Tube Damage or Blockage

The fallopian tubes carry the egg from the ovary to the uterus. If blocked or scarred, fertilization cannot occur. Common causes include:

• Pelvic inflammatory disease (PID)
• Endometriosis
• Prior surgeries
• Ectopic pregnancy history

Damage to the tubes may require surgical intervention or assisted reproductive technology (ART), such as in vitro fertilization (IVF).

Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. It can affect the ovaries, fallopian tubes, or other pelvic structures, leading to inflammation and scarring that interfere with fertility. Endometriosis is frequently underdiagnosed, but can be managed with medical or surgical treatment aimed at preserving reproductive function.

Uterine or Cervical Abnormalities

Problems in the uterus or cervix can prevent implantation or disrupt early pregnancy. These may include:

• Fibroids (noncancerous growths)
• Polyps
• Adhesions from previous surgeries or infections
• Abnormal cervical mucus production

Most structural issues can be identified via imaging or hysteroscopy and may be treated through minimally invasive procedures.

Age-Related Decline

A woman’s fertility naturally declines with age, particularly after age 35. Egg quality and quantity decrease, and the risk of miscarriage increases. Although age-related infertility is natural, it can be emotionally challenging. Understanding how age impacts fertility helps inform decision-making and timelines for care.

What Are the Signs That Fertility Might Be an Issue?

• Irregular or absent menstrual cycles
• Very painful periods
• History of pelvic infections or STIs
• Prior miscarriage or difficulty conceiving
• Diagnosed conditions like PCOS or endometriosis
• History of abdominal or pelvic surgery
• Age over 35 with no pregnancy after six months of trying

Sometimes, no obvious symptoms appear until pregnancy efforts begin. Regular gynecologic care and open conversations with a provider can help identify risks early.

How Is Female Fertility Evaluated?

Medical History and Physical Exam

A thorough review of cycles, sexual history, lifestyle factors, and past diagnoses is followed by a pelvic exam.

Ovulation Testing

Tracking ovulation with home kits, blood hormone levels (LH, FSH, estrogen, progesterone), or ultrasound confirms if and when ovulation occurs.

Imaging Studies

Transvaginal ultrasound can evaluate the uterus and ovaries. A hysterosalpingogram (HSG) checks fallopian tube patency. Hysteroscopy evaluates the uterine cavity directly.

Ovarian Reserve Testing

Tests like AMH (anti-Müllerian hormone) and antral follicle count measure remaining egg supply.

Other Tests

Depending on symptoms, thyroid levels, prolactin, or genetic testing may be done. Evaluation is typically started after 12 months of trying (<35) or 6 months (≥35).

How Are Common Fertility Issues Treated?

Ovulation Induction

Medications such as clomiphene citrate or letrozole stimulate ovulation. These may be combined with timed intercourse or intrauterine insemination (IUI).

Hormone Therapy

Corrects thyroid dysfunction, high prolactin, or other imbalances to restore ovulation.

Surgery

Minimally invasive surgery may remove fibroids, polyps, unblock tubes, or treat endometriosis lesions.

Intrauterine Insemination (IUI)

Sperm is placed directly in the uterus around ovulation to improve chances of fertilization.

In Vitro Fertilization (IVF)

IVF bypasses fallopian tubes, fertilizing eggs outside the body before implantation. Often used when other treatments fail or for complex issues.

What Role Does Lifestyle Play in Fertility?

• Weight: Both underweight and overweight can disrupt ovulation.
• Exercise: Moderate activity helps, but excessive exercise may suppress ovulation.
• Nutrition: Whole foods, healthy fats, and antioxidants support reproductive health.
• Alcohol & caffeine: Excess may impair fertility.
• Smoking: Damages eggs and accelerates ovarian aging.
• Stress: Chronic stress can affect hormones and ovulation.

Lifestyle changes cannot fix all fertility issues but can improve outcomes and treatment effectiveness.

How Does Age Affect Fertility and Egg Quality?

• Fertility begins to decline in the early 30s
• Decline accelerates after 35
• By 40, chances of natural conception are significantly reduced

Egg quantity and quality decrease with age, but conception is still possible with or without assistance. Early evaluation and preservation options can help.

What About Fertility Preservation?

Egg freezing allows individuals to preserve fertility. It’s most effective in the early to mid-30s but can be considered later. It involves stimulating ovaries, retrieving eggs, and freezing them for future use. It is particularly valuable for those delaying family planning, undergoing medical treatments, or with a family history of early menopause.

When Should You Seek Help?

• Trying to conceive for 6–12 months without success
• Irregular or painful periods
• Known conditions like PCOS or endometriosis
• Over 35 and planning to start a family
• Considering fertility preservation

Proactive evaluation doesn’t mean something is wrong—it means being thoughtful about your health and future.

Can Irregular Periods Affect Fertility?

Yes. Irregular cycles often mean ovulation is inconsistent, making conception difficult. Causes include hormonal imbalances, thyroid issues, stress, weight changes, PCOS, or perimenopause. Treatment involves cycle tracking, hormonal therapies, lifestyle changes, or ovulation induction medications.

How Do Polycystic Ovary Syndrome (PCOS) and Fertility Relate?

PCOS is a common but manageable cause of infertility. It disrupts hormonal balance and ovulation, leading to irregular or absent periods. Not all individuals have visible cysts. Symptoms may include acne, hair growth, weight gain, and fertility issues.

Treatment options include lifestyle modifications, ovulation induction medications, insulin-sensitizing drugs, monitoring, and IVF when necessary.

How Does Emotional Well-Being Impact the Fertility Journey?

Fertility struggles can cause anxiety, frustration, sadness, and strain relationships. Stress may worsen hormone imbalances, though it is more often a result of infertility than the cause. Supportive strategies include therapy, support groups, mindfulness, couples counseling, and setting boundaries with social triggers. Emotional well-being is as important as medical treatment.