Female Infertility: Causes, Signs, and Treatment Options Explained
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026
What Is Female Infertility?
Female infertility is defined as trying to get pregnant with frequent, unprotected sex for at least a year without success. It is far more common than most people realize, and far less final than the word suggests.
Infertility results from female factors about one-third of the time. Both female and male factors account for another third. In the remaining cases, the cause is unknown or a combination of factors.
Here is an encouraging fact worth repeating: many infertile couples go on to conceive a child without any treatment at all.
Symptoms: How Do You Know You're Infertile?
The main symptom of infertility is simply the inability to get pregnant. There might be no other signs at all.
One clue worth tracking is your menstrual cycle. A cycle that is too long (35 days or more), too short (less than 21 days), irregular, or absent can mean that you are not ovulating. If ovulation is not happening, conception cannot either.
When to See a Doctor: The Age-Based Rule
When to seek help depends largely on your age. Medical guidance follows a clear timeline.
Up to 35: Try to get pregnant for at least one year before testing or treatment.
35 to 40: Discuss concerns with your doctor after six months of trying.
Older than 40: Testing or treatment may begin right away.
You should also consider starting testing or treatment immediately, at any age, if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, cancer treatment, or endometriosis.
How Conception Works (and Where It Can Break Down)
For pregnancy to occur, every step of the human reproduction process has to happen correctly. Understanding the steps makes it much easier to understand where things can go wrong.
First, one of the two ovaries releases a mature egg. The egg is picked up by the fallopian tube. Sperm then swim up through the cervix and uterus into the fallopian tube to reach the egg for fertilization. The fertilized egg travels down the fallopian tube to the uterus. Finally, it attaches (implants) to the inside of the uterus and grows.
The reproductive organs involved are the ovaries, fallopian tubes, uterus, cervix, and vagina (also called the vaginal canal).
The Five Main Causes of Female Infertility
In women, a number of factors can disrupt the conception process at any step. These are the five cause families.
1. Ovulation Disorders
Ovulating infrequently or not at all accounts for most cases of infertility. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or problems in the ovary itself, can cause ovulation disorders.
Polycystic ovary syndrome (PCOS) causes a hormone imbalance that affects ovulation. It is associated with insulin resistance, obesity, abnormal hair growth on the face or body, and acne. It is the most common cause of female infertility.
Hypothalamic dysfunction disrupts two pituitary hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — that stimulate ovulation each month. Excess physical or emotional stress, a very high or very low body weight, or recent substantial weight gain or loss can disrupt these hormones. Irregular or absent periods are the most common signs.
Primary ovarian insufficiency, also called premature ovarian failure, is usually caused by an autoimmune response or premature loss of eggs from the ovary, possibly from genetics or chemotherapy. The ovary stops producing eggs and lowers estrogen production in women under 40.
Too much prolactin (hyperprolactinemia) is excess production by the pituitary gland that reduces estrogen production and can cause infertility. It can also be caused by medications taken for another condition.
2. Damage to Fallopian Tubes (Tubal Infertility)
Damaged or blocked fallopian tubes keep sperm from reaching the egg, or block the fertilized egg's passage into the uterus. Common causes include pelvic inflammatory disease — an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea, or other sexually transmitted infections — and previous surgery in the abdomen or pelvis, including surgery for an ectopic pregnancy, in which a fertilized egg implants and develops somewhere other than the uterus, usually in a fallopian tube.
3. Endometriosis
Endometriosis occurs when tissue that typically grows in the uterus implants and grows in other places. This tissue growth — and the surgery to remove it — can cause scarring that blocks fallopian tubes and keeps an egg and sperm from uniting.
Endometriosis can also disrupt implantation of the fertilized egg, and it seems to affect fertility in less-direct ways, such as damage to the sperm or the egg.
4. Uterine or Cervical Causes
Several uterine or cervical factors can interfere with implantation or increase miscarriage risk. Benign polyps or tumors (fibroids or myomas) are common in the uterus; some block the fallopian tubes or interfere with implantation, though many women with fibroids or polyps do become pregnant.
Other factors include problems present from birth, such as an unusually shaped uterus; cervical stenosis, a narrowing of the cervix caused by an inherited malformation or damage; and cases where the cervix cannot produce the best type of mucus to let sperm travel through into the uterus.
5. Unexplained Infertility
In some cases, the cause of infertility is never found. A combination of several minor factors in both partners could be responsible. Although getting no specific answer is frustrating, this problem can correct itself with time — but treatment should not be delayed while waiting.
Risk Factors: Who Is More Likely to Experience Infertility?
Age: Egg quality and quantity decline with age; follicle loss speeds up in the mid-30s, leaving fewer and poorer quality eggs, making conception harder and raising miscarriage risk.
Smoking: Damages the cervix and fallopian tubes, increases miscarriage and ectopic pregnancy risk, and is thought to age the ovaries and deplete eggs prematurely — stop before starting fertility treatment.
Weight: Being overweight or significantly underweight may affect ovulation; a healthy BMI can increase ovulation frequency and pregnancy likelihood.
Sexual history: STIs such as chlamydia and gonorrhea can damage the fallopian tubes; unprotected sex with multiple partners raises infection risk and later fertility problems.
Alcohol: Excess alcohol consumption can reduce fertility.
Can Infertility Be Prevented?
For women thinking about getting pregnant soon or in the future, several habits may help protect fertility.
Maintain a healthy weight, since overweight and underweight women face increased risk of ovulation disorders. If you need to lose weight, exercise moderately — strenuous, intense exercise of more than five hours a week has been associated with decreased ovulation.
Quit smoking. Tobacco has multiple negative effects on fertility, your general health, and the health of a fetus. If you smoke and are considering pregnancy, quit now.
Avoid alcohol. Heavy use may decrease fertility, and any alcohol can affect a developing fetus. If you plan to become pregnant, avoid alcohol, and do not drink while pregnant.
Finally, reduce stress. Some studies have shown that stress can cause couples to have poorer results with infertility treatment.
How Is Female Infertility Diagnosed?
If you have been unable to conceive within a reasonable time, seek help from your doctor for evaluation and treatment. You and your partner should both be evaluated. Your doctor will take a detailed medical history and conduct a physical exam.
Ovulation testing: An at-home, over-the-counter prediction kit detects the luteinizing hormone (LH) surge before ovulation; a progesterone blood test can document ovulation; other hormones such as prolactin may also be checked.
Hysterosalpingography: X-ray contrast is injected into the uterus and an X-ray is taken; it shows problems inside the uterus and whether fluid spills out of the fallopian tubes, indicating they are open.
Ovarian reserve testing: A series of blood and imaging tests that determine the quality and quantity of eggs available; often offered to women older than 35 or those at risk of a depleted egg supply.
Other hormone testing: Checks ovulatory hormones as well as thyroid and pituitary hormones that control reproductive processes.
Imaging tests: A pelvic ultrasound looks for uterine or fallopian tube disease; a sonohysterogram (saline infusion sonogram) or hysteroscopy can reveal details inside the uterus that a regular ultrasound cannot.
Depending on your situation, testing rarely might also include a laparoscopy — a minimally invasive surgery with a small incision beneath the navel and a thin viewing device to examine the fallopian tubes, ovaries, and uterus for endometriosis, scarring, blockages, or irregularities — or genetic testing to find gene changes that may be causing infertility.
Treatment Options
Infertility treatment depends on the cause, your age, how long you have been infertile, and personal preferences. Because infertility is complex, treatment involves significant financial, physical, psychological, and time commitments.
Treatments either restore fertility through medication or surgery, or help you get pregnant using advanced techniques.
Medications to Restore Fertility
Medications that regulate or stimulate ovulation are called fertility drugs, and they are the main treatment for women whose infertility stems from ovulation disorders. They generally work like natural hormones (FSH and LH) to trigger ovulation, and can also stimulate a better egg or extra eggs in women who already ovulate.
Clomiphene citrate: Taken by mouth; makes the pituitary release more FSH and LH to stimulate ovulation; usually first-line treatment for women younger than 39 without PCOS.
Gonadotropins (hMG/Menopur, FSH/Gonal-F, Follistim AQ, Bravelle; hCG/Ovidrel, Pregnyl): Injected to stimulate the ovary to produce multiple eggs; hCG matures eggs and triggers their release; higher risk of multiples and premature delivery.
Metformin (Fortamet): Improves insulin resistance when it is a known or suspected cause, usually in women with PCOS, improving the likelihood of ovulation.
Letrozole (Femara): An aromatase inhibitor working similarly to clomiphene; usually for women younger than 39 with PCOS.
Bromocriptine (Cycloset, Parlodel): A dopamine agonist used when excess prolactin (hyperprolactinemia) causes ovulation problems.
Risks of fertility drugs are real but manageable. Oral medications carry a fairly low risk of multiple pregnancy (under 10%, mostly twins), while injectables raise the chance of multiples up to 30% — including triplets or more. Carrying multiple fetuses increases the risk of premature labor, low birth weight, and later developmental problems; adjusting medications when too many follicles develop can lower this risk.
Injected fertility drugs can also cause ovarian hyperstimulation syndrome (OHSS), which is rare. The mild form — swollen, painful ovaries with abdominal pain, bloating, nausea, vomiting, and diarrhea — usually resolves without treatment. A severe form can bring rapid weight gain, enlarged painful ovaries, fluid in the abdomen, and shortness of breath.
As for long-term risks, most studies of fertility drug users suggest few if any long-term problems. A few studies suggest women taking fertility drugs for 12 or more months without a successful pregnancy might face increased risk of borderline ovarian tumors later in life. Since success rates are typically highest in the first few treatment cycles, reevaluating medication use every few months is appropriate.
Surgery to Restore Fertility
Several surgical procedures can correct problems or improve fertility, though surgical treatment is rare today due to the success of other options. Laparoscopic or hysteroscopic surgery can correct uterine anatomy, remove endometrial polyps and certain fibroids that misshape the uterine cavity, or remove pelvic and uterine adhesions.
Tubal surgery — removing adhesions, dilating a tube, or creating a new tubal opening — is also rare, since pregnancy rates are usually better with in vitro fertilization (IVF). However, removing blocked tubes or blocking them close to the uterus can improve IVF chances.
Reproductive Assistance
When medication and surgery are not enough, two assisted methods are commonly used. Intrauterine insemination (IUI) places millions of healthy sperm directly inside the uterus around the time of ovulation.
Assisted reproductive technology (ART) involves retrieving mature eggs, fertilizing them with sperm in a lab dish, and transferring the embryos into the uterus after fertilization. IVF is the most effective assisted reproductive technology. An IVF cycle takes several weeks and requires frequent blood tests and daily hormone injections.
Conclusion: What to Do Next
If you have been trying for a year (or six months if you are 35 or older) without success, the most important step is to get evaluated — and remember that both partners should be, since causes are shared across all three categories. Start charting your cycles now, and if the cause turns out to be one of the five covered here, matching tests and treatments exist for each one.
Your next steps:
Begin a menstrual cycle chart today — record start and stop dates, cervical mucus changes, and days of intercourse.
Book an appointment with your doctor (or a reproductive endocrinologist) if you meet the timeline above.
Bring previous medical records and a complete list of medications, vitamins, herbs, and supplements.
In the meantime, support your fertility naturally: maintain a healthy weight, quit smoking, avoid alcohol, and reduce stress.
Frequently Asked Questions
What is considered female infertility?
Female infertility is defined as trying to get pregnant with frequent, unprotected sex for at least a year with no success. Infertility results from female factors about one-third of the time, with both partners' factors and unknown causes accounting for the rest.
How do you know if you're infertile?
The main symptom is the inability to get pregnant, sometimes with no other signs. A menstrual cycle that is too long (35 days or more), too short (under 21 days), irregular, or absent can signal that you are not ovulating, which prevents conception.
When should I see a doctor for trouble getting pregnant?
Under 35, try for at least a year before testing; ages 35 to 40, see your doctor after six months of trying; over 40, testing or treatment may begin right away. Seek immediate evaluation at any age with a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, endometriosis, cancer treatment, or known fertility problems.
What is the most common cause of female infertility?
Ovulation disorders — ovulating infrequently or not at all — account for most cases. Polycystic ovary syndrome (PCOS), a hormone imbalance often linked to insulin resistance, obesity, acne, and excess hair growth, is the single most common cause of female infertility.
Can female infertility be treated?
Yes. Treatment depends on the cause and may include fertility medications like clomiphene, letrozole, gonadotropins, or metformin; rarely, surgery; or reproductive assistance such as intrauterine insemination (IUI) or in vitro fertilization (IVF), the most effective assisted technology. Many infertile couples also conceive without treatment.
Does IVF work for female infertility?
IVF — retrieving mature eggs, fertilizing them with sperm in a lab, and transferring embryos to the uterus — is the most effective assisted reproductive technology. A cycle takes several weeks and requires frequent blood tests and daily hormone injections, and it can help even when fallopian tubes are blocked.
References
Health information, not medical advice. This article is for general education and is not a substitute for professional diagnosis or treatment. Always consult a qualified healthcare provider about your own health, and seek emergency care for urgent symptoms.
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