What is the leading cause of female infertility?

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The leading cause of fertility challenges in females is due to problems with ovulation.

Polycystic ovary syndrome (PCOS) affects 7% to 15% of females of reproductive age and is one of the main causes of ovulation problems leading to fertility challenges. Infertility affects 70% to 80% of females with PCOS.

PCOS is a hormone imbalance that creates problems with the development and release of the egg with ovulation.

Another ovulation problem is primary ovarian insufficiency (POI), which can affect fertility. POI occurs if the ovaries stop working as normal before the age of 40 years. It causes someone to have irregular periods or none at all.

Endometriosis is another common condition that can cause fertility challenges. It happens when tissue similar to the uterus lining, the endometrium, grows outside of the uterus.

Endometriosis affects almost 10% of females of reproductive age, and infertility occurs in one-third of these cases. Up to 50% of females with infertility also have endometriosis.

Structural problems can also cause infertility in females. Problems with the fallopian tubes can block them and cause fertility issues. This may occur with:

• pelvic inflammatory disease (PID)
• surgery for ectopic pregnancy
• sexually transmitted infections (STIs) that may scar or block the fallopian tubes

Problems with the uterus or cervix may also cause fertility challenges, such as uterine fibroids, which are benign growths on the walls of the uterus.

Normal production of thyroid hormones is essential for regulating the female reproductive system. Thyroid dysfunction can cause changes to the menstrual cycle and fertility problems.

Sometimes, there is no known cause of fertility challenges in females. According to a 2023 study, around 30% of infertility cases have no known cause. The study suggests genetic variants may play a role in some cases of unexplained infertility.

Other factors, including lifestyle and diet, can affect fertility. Risk factors for fertility challenges include:

• Age: The chance of getting pregnant starts declining for females in their 30s and significantly decreases by the age of 40.
• Weight: Being overweight or underweight, as well as excessive exercise, can increase the risk of experiencing fertility challenges.
• Alcohol: Moderate or heavy alcohol consumption can reduce fertility.
• Smoking: Smoking can reduce fertility, damage the reproductive system, and negatively affect hormone production.
• Stress: Stress and mental health issues, such as anxiety and depression, may link to fertility problems.

Experts define infertility as the inability to get pregnant after 1 year of regular sex with no birth control, or after 6 months in females who are ages 35 years and above.

Depending on the underlying cause of fertility struggles in females, people may also experience other symptoms, such as:

• irregular or absent periods
• changes to their menstrual cycle, such as heavy bleeding
• painful periods
• short or long menstrual cycle, either less than 21 days or longer than 35 days
• pelvic pain

To diagnose fertility issues in females, doctors may carry out a range of tests to check hormone levels and the health of reproductive organs. This may include:

• Blood tests: To check progesterone and prolactin levels, thyroid function, and ovarian reserve.
• Urine tests: To check luteinizing hormone (LH) levels to identify if and when people are ovulating.
• Imaging scans: Such as ultrasounds and X-rays to examine the reproductive organs and check the follicles, uterus, and fallopian tubes.
• Hysteroscopy: A doctor inserts a thin tube with a camera and light through the cervix to the uterus to check for problems.
• Laparoscopy: A doctor inserts a thin tube with a light and camera through a small incision in the abdomen to check the ovaries, fallopian tubes, and outside of the uterus.

Doctors may be able to diagnose fertility problems over the course of a few menstrual cycles.

Various treatments can be effective for fertility challenges in females and may include lifestyle changes, medications, and surgical procedures.

Lifestyle changes may include:

• eating a balanced diet to ensure the body is getting the nutrients it needs to optimize fertility
• eliminating risk factors, such as smoking, excessive alcohol, and excessive exercise
• maintaining a healthy weight

Medical treatments for fertility challenges may include:

• Hormone therapy: Certain drugs may induce ovulation, such as clomiphene citrate, aromatase inhibitors, or gonadotropins.
• In vitro fertilization (IVF): IVF combines the sperm with the egg outside of the body in a laboratory, and then a doctor transfers the embryo into the uterus.
• Intrauterine insemination (IUI): IUI involves the placement of sperm from a partner or donor into the uterus close to ovulation.
• Surgery: To correct problems with the reproductive organs or to treat endometriosis.

Learn more about fertility drugs for women.

Experts suggest contacting a doctor after 1 year of trying to become pregnant, after 6 months if over the age of 35, or straight away if they are over the age of 40.

People can contact a doctor if they have any symptoms which may suggest fertility issues, including:

• abnormalities in their menstrual cycle
• irregular or absent periods
• painful periods
• pelvic pain
• more than one pregnancy loss

If people are facing fertility challenges, they may find the following resources helpful:

• Resolve – The National Infertility Association
• American Society for Reproductive Medicine (ASRM)
• Society for Reproductive Assisted Technology (SART)
• Illume Fertility – Support Groups and Events

The leading cause of female infertility is ovulation problems, such as PCOS. Other causes can include problems with the reproductive organs or thyroid dysfunction. Diet and lifestyle are also important factors.

People can discuss any fertility issues with a doctor and undergo a fertility evaluation. Treatment options may include lifestyle changes, medication, or surgery.