Fertility difficulties in women can involve ovulation, the fallopian tubes, the uterus or conditions such as endometriosis. Age also matters. Sometimes there is more than one factor, and sometimes standard tests do not find a cause.
A list of possible causes cannot tell you why pregnancy has not happened for you. It can help you understand what a clinician may investigate and what to mention at an appointment.
Fertility is not only a woman’s issue
When a couple is trying to conceive, factors affecting either partner, or both, may be involved. Assessment should include the person providing sperm where relevant, rather than placing all the testing or responsibility on the woman.
This article focuses on female fertility because that is the question many readers have. It is not a checklist of things you should have prevented.
Ovulation problems
Ovulation is the release of an egg from an ovary. If it happens infrequently or not at all, there are fewer opportunities for conception. Irregular or absent periods can be a clue, although they do not identify the cause on their own.
Polycystic ovary syndrome (PCOS) can interfere with ovulation. Thyroid conditions and other hormonal problems can also play a part. Treatment depends on the underlying problem, so a home ovulation test is not a substitute for assessment.
Age and changes in ovarian function
The number and quality of eggs change with age, and the chance of pregnancy declines, particularly after 35. IVF cannot fully reverse this change. Age is useful information for planning care, not a reason to blame yourself for when you started trying.
Premature ovarian insufficiency is another possible cause of reduced ovarian function at a younger age. A clinician needs to investigate it; a change in periods alone does not establish the diagnosis.
Blocked or damaged fallopian tubes
The fallopian tubes are where egg and sperm usually meet. Blockage or scarring can make this difficult. Previous pelvic inflammatory disease, including disease caused by untreated sexually transmitted infections, can damage the tubes. Previous pelvic surgery may also be relevant.
Tell your clinician about past infections or operations even if they were years ago. Having had an infection does not automatically mean your tubes are damaged.
Endometriosis
Endometriosis involves tissue similar to the lining of the uterus growing outside it. It can affect fertility, but many people with endometriosis become pregnant.
If you have known endometriosis, significant period pain or pain with sex, seek advice rather than waiting for an arbitrary trying period to pass. Pregnancy, Birth and Baby explains endometriosis and fertility.
Conditions affecting the uterus
Some fibroids, polyps or scarring within the uterus can affect fertility. Their location and effect matter. Most people with fibroids have normal fertility, so finding a fibroid does not automatically mean it caused a problem or needs removing.
Your clinician may recommend imaging and discuss whether a finding is relevant to you. See the Australian guidance on fibroids and fertility.
Health conditions, treatments and everyday factors
Some health conditions and treatments can affect reproductive function. Bring a full medicine list to your appointment and mention previous cancer treatment. Do not stop prescribed treatment because you are concerned about fertility; ask the prescriber to review it.
Smoking and changes in nutrition or body weight can also affect fertility. Advice should be practical and individual, especially if you have an eating disorder or are managing chronic illness. Lifestyle changes cannot explain or resolve every fertility difficulty, and care should not be delayed while you try to make everything perfect.
What does unexplained infertility mean?
It means standard assessment has not identified a clear reason for the difficulty conceiving. It does not mean there are no options. Ask what has been assessed, what further tests would change, and which approaches are reasonable for your circumstances.
If you have become pregnant but experienced repeated miscarriages, tell your GP. Pregnancy loss needs its own assessment; it should not simply be treated as the same question as difficulty conceiving.
When to see a doctor
Seek assessment after 12 months of regular sex without contraception if you are under 35, or after six months if you are 35 or older. Ask sooner for absent or irregular periods, a known fertility condition, significant pelvic symptoms or concerns about a partner’s fertility.
If pregnancy is possible and you develop severe abdominal or pelvic pain, shoulder-tip pain, heavy bleeding, dizziness or fainting, seek emergency care. Call 000 for an emergency. Do not wait for a routine fertility appointment or a positive home test.
You can read about fertility tests and treatment options, or use our guide to timing and practical steps when trying to conceive.
Sources
- Better Health Channel: infertility in women
- NICHD: causes of female infertility
- Your Fertility: age and fertility
- Pregnancy, Birth and Baby: trying after 35
- Pregnancy, Birth and Baby: recurrent miscarriage
- Healthdirect: ectopic pregnancy
This is general information, not a diagnosis. Your GP or fertility specialist can help interpret your symptoms, history and test results.