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.