Infertility in Women: Common Causes and When to Seek Help
Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse (or 6 months if the woman is over 35). It affects approximately 10–15% of couples worldwide. Understanding the causes and knowing when to seek evaluation can save valuable time in the journey toward parenthood.
Common Causes of Female Infertility
1. Ovulatory Disorders (25–30% of cases)
Irregular or absent ovulation is the most common cause. Conditions include PCOS, hypothalamic dysfunction (often related to stress, extreme weight changes, or excessive exercise), premature ovarian insufficiency, and hyperprolactinemia.
2. Tubal Factor (25–35%)
Blocked or damaged fallopian tubes prevent the egg from meeting sperm. Common causes include pelvic inflammatory disease (PID), previous ectopic pregnancy, endometriosis, and prior pelvic surgery.
3. Endometriosis (10–15%)
Endometrial tissue growing outside the uterus can cause inflammation, adhesions, and damage to the ovaries and tubes. Even mild endometriosis can impair fertility through inflammatory effects on egg quality and implantation.
4. Uterine Factors (5–10%)
Fibroids (especially submucosal), polyps, intrauterine adhesions (Asherman syndrome), and congenital uterine anomalies can interfere with implantation.
5. Age-Related Decline
Female fertility begins to decline gradually after age 30 and more rapidly after 35. This is primarily due to a decrease in both the number and quality of eggs. By age 40, the chance of natural conception per cycle drops to about 5%.
When to Seek Evaluation
- Under 35 years: after 12 months of trying
- 35–40 years: after 6 months of trying
- Over 40 years: seek evaluation promptly
- At any age if there are known risk factors such as irregular periods, history of PID, endometriosis, or prior pelvic surgery
Basic Fertility Evaluation
A thorough evaluation typically includes hormonal blood tests (FSH, LH, AMH, thyroid, prolactin), pelvic ultrasound to assess the ovaries and uterus, hysterosalpingography (HSG) or sono-salpingography to check tubal patency, and semen analysis for the male partner.
Treatment Options
Treatment depends on the underlying cause and may range from ovulation induction with oral medications, to intrauterine insemination (IUI), to in-vitro fertilization (IVF). Surgical correction of fibroids, polyps, or tubal blockages may also be recommended.
Infertility is a medical condition, not a personal failing. Modern reproductive medicine offers multiple pathways to parenthood, and early evaluation provides the widest range of options.
