Published: 18 Jun 2025

ICD9: 628.9      ICD10: N97.9      ICD11: GA31

Infertility in women refers to the inability to conceive after one year of regular, unprotected sexual intercourse, or after six months if the woman is 35 years or older.
It can also refer to the inability to carry a pregnancy to term (recurrent miscarriage).

Here's a breakdown of key aspects of female infertility:

Definition:

Timeframe: One year of trying to conceive (TTC) through regular, unprotected sex for women under 35. Six months for women 35 and older. The reduced timeframe for older women is due to the natural decline in egg quality and quantity with age.
Regular intercourse: Generally defined as having sexual intercourse 2-3 times per week.
Unprotected: Without the use of contraception.
Carrying to term: Repeated pregnancy loss (miscarriage) also falls under the umbrella of infertility.

Causes:

Female infertility is often multifactorial, meaning it can stem from one or a combination of issues. Common causes include:

Ovulation disorders: Problems with the release of eggs.
Polycystic Ovary Syndrome (PCOS): A hormonal disorder that can cause irregular ovulation or no ovulation at all.
Premature Ovarian Insufficiency (POI) (also known as premature menopause): The ovaries stop working before age 40.
Hypothalamic dysfunction: Problems with the hypothalamus gland, which controls hormone production.
Hyperprolactinemia: Excessive production of prolactin, which can interfere with ovulation.
Thyroid problems: Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can affect ovulation.

Fallopian tube damage or blockage: Prevents the egg from traveling to the uterus or the sperm from reaching the egg.
Pelvic Inflammatory Disease (PID): Often caused by sexually transmitted infections (STIs).
Endometriosis: A condition where the tissue that normally lines the uterus grows outside of it.
Surgery: Prior abdominal or pelvic surgery.

Uterine abnormalities: Problems with the uterus that can interfere with implantation or carrying a pregnancy.
Fibroids: Noncancerous growths in the uterus.
Polyps: Growths in the uterine lining.
Asherman's Syndrome: Scar tissue in the uterus.
Uterine malformations: Abnormalities in the shape of the uterus.

Endometriosis: As mentioned above, this can affect ovulation, fallopian tubes, and the uterus.

Egg quality: The quality of a woman's eggs declines with age, making it harder to conceive and increasing the risk of miscarriage. Egg quality can also be affected by genetics and lifestyle factors.

Cervical factors: Problems with the cervix, such as cervical stenosis (narrowing of the cervical canal) or cervical mucus issues, can interfere with sperm transport.

Unexplained infertility: In some cases, no cause can be identified despite thorough testing.

Risk Factors:

Certain factors can increase a woman's risk of infertility:

Age: As women age, their fertility naturally declines.
Smoking: Smoking can damage eggs and affect hormone levels.
Excessive alcohol consumption: Can negatively impact fertility.
Obesity or being underweight: Can disrupt hormone balance and ovulation.
History of STIs: Can lead to PID and fallopian tube damage.
Prior surgery on the ovaries or fallopian tubes.
Certain medical conditions: Such as diabetes, thyroid disorders, and autoimmune diseases.
Family history of infertility.

Symptoms:

The most common symptom of infertility is the inability to get pregnant. Other potential symptoms may include:

Irregular menstrual cycles: Very long, short, or absent periods.
Painful periods: May indicate endometriosis.
Pelvic pain: May indicate endometriosis or other pelvic problems.
Known or suspected medical conditions: Such as PCOS or thyroid disorders.

Diagnosis:

A fertility evaluation typically involves:

Medical history: Review of a woman's medical history, including menstrual cycles, prior pregnancies, and medical conditions.
Physical exam: A general physical exam, including a pelvic exam.
Hormone testing: Blood tests to check hormone levels, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, progesterone, and thyroid hormones.
Ovulation testing: Tracking ovulation through basal body temperature charting, ovulation predictor kits, or blood tests.
Hysterosalpingogram (HSG): An X-ray that checks the fallopian tubes for blockages.
Ultrasound: To examine the uterus and ovaries for abnormalities.
Laparoscopy: A minimally invasive surgical procedure to visualize the pelvic organs and identify problems such as endometriosis or adhesions.
Hysteroscopy: A procedure to examine the inside of the uterus.

Treatment:

Treatment options for female infertility depend on the underlying cause and may include:

Fertility drugs: Medications to stimulate ovulation. Examples include clomiphene citrate (Clomid) and letrozole (Femara).
Intrauterine insemination (IUI): Sperm is placed directly into the uterus around the time of ovulation.
In vitro fertilization (IVF): Eggs are retrieved from the ovaries, fertilized with sperm in a lab, and then transferred to the uterus.
Surgery: To correct structural problems in the uterus, fallopian tubes, or ovaries.
Lifestyle changes: Such as quitting smoking, losing weight, and reducing alcohol consumption.
Third-party reproduction: Using donor eggs, sperm, or a surrogate.

When to see a doctor:

It's recommended to see a doctor if:

You've been trying to conceive for one year without success (if you're under 35).
You've been trying to conceive for six months without success (if you're 35 or older).
You have irregular periods or other menstrual problems.
You have a history of pelvic inflammatory disease (PID), endometriosis, or other reproductive problems.
You have had multiple miscarriages.
You have any concerns about your fertility.

Important Considerations:

Infertility is a complex issue, and it's important to seek help from a qualified fertility specialist.
Both male and female factors can contribute to infertility.
Treatment options are available, and many couples are able to conceive with the help of fertility treatments.
Infertility can be emotionally challenging, and it's important to seek support from family, friends, or a therapist.

This information is intended for general knowledge and does not substitute for professional medical advice. Always consult with a healthcare provider for any health concerns or before making any decisions related to your health or treatment.