Infertility in Females – Causes and Testing

Female infertility is a contributing factor in about one-third of fertility cases. It’s important to understand the common causes of infertility in women and know how to identify them. In women over 35, age-related infertility is common. In younger women, reproductive conditions, such as polycystic ovarian syndrome and endometriosis, are among the most common causes of female infertility.  The fertility specialists at CRE understand all aspects of female infertility and can offer patients expert advice on your reproductive condition and next steps.

Reproductive Conditions

Some of the most common causes of female infertility are reproductive conditions. Diseases that affect the ovaries, uterus, Fallopian tubes, and other associated organs can interfere with ovulation, fertilization, or implantation in a number of ways. Two of the most common reproductive conditions are endometriosis and polycystic ovarian syndrome. During your infertility assessment, Dr. Walid Saleh will review your family history and current symptoms to assess if testing for these conditions is necessary.


Endometriosis is a condition that occurs when segments of the uterine lining, or endometrium, grow on structures outside of the uterus. Endometriosis can result in female infertility and often causes severe menstrual cramps and other pelvic pain, fatigue, and abnormal menstrual bleeding. Additionally, the tissues from the endometrial lesions can cause inflammation, scarring, and cysts due to their inability to exit the body.

Endometriosis is diagnosed using a laparoscopic examination wherein a camera attached to a thin tube is inserted in the abdomen, allowing the physician to determine the extent of endometrial growth. Depending on the severity of the problem, endometriosis may be treated with surgery, medication, or both.

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS), another leading cause of female infertility, is an endocrine condition that interferes with ovulation. Rather than a single ovarian follicle developing and releasing a mature egg each cycle, multiple ovarian cysts form but do not release any eggs. Common symptoms of PCOS include irregular menstruation, obesity, insulin resistance, excess body hair, acne, and thinning hair on the head.

While not curable, PCOS is treatable. To overcome infertility caused by polycystic ovarian syndrome, clomiphene citrate is generally prescribed to restore normal ovulation. When obesity is a factor, weight loss and dietary changes will usually restore normal menstruation and ovulation. If these changes are ineffective, Dr. Walid Saleh will discuss alternative treatment options for you.

Age-Related Infertility

Fertility begins to decline in women over the age of 30 as their egg reserve declines and hormonal changes make conception and pregnancy more difficult. Age-related fertility issues are progressive, meaning the longer you wait to seek treatment, the less likely it becomes that assisted reproductive technology will be effective. Additionally, the chance of fetal abnormalities and genetic mutations increases.

Ovulation Disorders

Irregular or absent ovulation may be the result of premature ovarian failure, a condition such as polycystic ovarian syndrome, or a different type of hormonal imbalance. Depending on the cause and severity of the problem, ovulation disorders can be some of the easiest or most difficult types of infertility to treat in females.

Physical Barriers

A blockage or barrier in the fallopian tubes or uterus is another common cause of infertility in females. These blockages may prevent the egg from coming into contact with sperm or implanting it in the uterine lining. To allow women with tubal blockages to become pregnant, In Vitro Fertilization (IVF) may be used. If a physical malformation of the uterus makes carrying a pregnancy impossible, the patient can still have a biological child through IVF with a gestational surrogate.

Hormone Imbalances

A hormone imbalance can cause female infertility by preventing the uterine lining from thickening, interfering with ovulation, or otherwise preventing pregnancy from becoming established. Luckily, hormone imbalances can usually be corrected through medication, lifestyle changes, or dietary changes once discovered.


Fertility can be decreased by lifestyle choices including drinking alcohol, smoking, drug use, or being sedentary. Treatments include proper diet, moderate exercise, and avoiding potentially harmful substances.


  • 1

    What is infertility in females?

    Infertility is defined as the failure to achieve a successful pregnancy after 12 months or more of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with her/ his partner.

  • 2

    Can you cure female infertility?

    Most couples with infertility will ultimately conceive one way or another. When ovulation is the issue, most women respond to oral medication like clomiphene or letrozole. Those with blocked tubes typically require IVF because surgery is not very effective at opening the tubes with a lasting effect. Women with no eggs or no male partner can still conceive with the use of an egg or sperm donor. Women who underwent hysterectomy can still have their own biological children through the use of a gestational surrogate.

  • 3

    Who is at risk for female infertility?

    Women with insulin resistance, high BMI and abnormal hair growth often develop ovulation problems (such as PCOS) which leads to infertility. Even without those health issues, women with irregular menstrual cycles are more likely to be infertile. Women with a history of sexually transmitted diseases or endometriosis are at risk for tubal adhesions and tubal factor infertility. Fertility and miscarriages are also affected by maternal age as the rate of chromosomal errors in the egg increases over time. Women with a history of chemotherapy or radiation therapy for cancer and women with certain genetic tendencies can face infertility due to diminished egg counts (diminished ovarian reserve or primary ovarian insufficiency).

  • 4

    Can infertile women have periods?

    Infertility is multi-factorial. Couples with male factor or tubal infertility will often have regular periods. Irregular or absent menstrual periods are often caused by a hormonal imbalance. Periods alone do not predict a chance for pregnancy success.

  • 5

    What defines infertility?

    Infertility is defined as a lack of pregnancy despite a year of trying.

  • 6

    How is infertility caused?

    Infertility is caused by multiple factors; In 1/3 of couples, infertility is caused by a male factor. In 2/3 of cases, infertility is due to female factors like tubal disease (35%), ovulatory dysfunction (20%), or may be unexplained (10%).

  • 7

    What are the signs of infertility in females?

    Infertility itself does not cause a particular symptom or sign, as it is a multi-factorial condition. The underlying conditions causing infertility, however, may be associated with specific symptoms. For example, fever, pain and vaginal discharge may indicate pelvic infections which often cause tubal scarring and infertility. Painful periods and pain with intercourse are signs of endometriosis which also can cause tubal scarring. Heavy regular periods can be a sign of uterine fibroids. Irregular periods suggest an underlying hormonal imbalance, associated with various symptoms of PCOS like weight gain, hirsutism, and pre-diabetes.

  • 8

    Is infertility a disease?

    Infertility is categorized as a disease by the World Health Organization, a designation supported by numerous professional associations including the American Medical Association (AMA), the European Society for Human Reproduction and Embryology (ESHRE), and the American Society for Reproductive Medicine (ASRM).

  • 9

    Is being infertile a disability?

    Per ASRM, “Infertility is a disease which generates disability as an impairment of function.”