What Are the Top 5 Causes of Female Infertility?
Infertility can be a distressing and often misunderstood condition, particularly for women who are trying to conceive. While it affects both men and women, female infertility accounts for approximately one-third of all infertility cases. Understanding the root causes is essential for early diagnosis, treatment, and emotional support.
In this article, we will explore the top five most common causes of female infertility, along with their symptoms, risk factors, diagnosis, and available treatments.
1. Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) is one of the leading causes of female infertility. It affects up to 10% of women of reproductive age and is characterised by hormonal imbalance and irregular ovulation.
Symptoms of PCOS:
- Irregular or missed periods
- Excess facial or body hair (hirsutism)
- Acne or oily skin
- Weight gain or difficulty losing weight
- Multiple small cysts on the ovaries (seen via ultrasound)
Why It Causes Infertility:
Women with PCOS often have irregular or absent ovulation, which means there’s no egg released for fertilisation. Hormonal imbalances can also affect the uterine lining, making it difficult for implantation to occur.
Treatment Options:
- Lifestyle changes like weight loss and exercise
- Medications to induce ovulation (e.g. Clomid, Letrozole)
- Metformin to regulate insulin levels
- IVF for severe cases
For further reading, visit our in-depth guide on managing PCOS and improving fertility.
2. Endometriosis
Endometriosis is a condition in which tissue similar to the uterine lining grows outside the uterus, often on the ovaries, fallopian tubes, or pelvic walls. This abnormal growth can cause inflammation, scarring, and adhesions that affect fertility.
Common Symptoms:
- Pelvic pain, especially during menstruation
- Pain during intercourse
- Heavy menstrual bleeding
- Digestive issues or painful bowel movements
- Fatigue
How It Impacts Fertility:
Endometriosis can distort the anatomy of the pelvis, block fallopian tubes, and interfere with egg quality and implantation. Inflammation may also negatively impact sperm and egg interaction.
Treatment Options:
- Pain management with NSAIDs
- Hormonal therapies (e.g. birth control, GnRH agonists)
- Laparoscopic surgery to remove endometrial growths
- Assisted reproductive technologies (ART) like IVF
Women with mild endometriosis may still conceive naturally, but moderate to severe cases often require medical assistance.
3. Ovulation Disorders
Ovulation disorders account for nearly 25% of female infertility cases. These disorders can prevent the release of eggs or cause inconsistent ovulation, making conception difficult.
Common Causes of Ovulation Disorders:
- Hypothalamic dysfunction (disruption in hormone signals from the brain)
- Premature Ovarian Insufficiency (POI)
- Hyperprolactinemia (excess production of prolactin hormone)
- Thyroid imbalances (hyperthyroidism or hypothyroidism)
Symptoms to Watch For:
- Irregular or absent periods
- Difficulty tracking ovulation
- Hot flashes or night sweats in younger women
Treatment Options:
- Ovulation-stimulating drugs (e.g. Clomiphene citrate, Gonadotropins)
- Hormonal therapy to correct underlying imbalances
- Addressing lifestyle factors like stress and diet
- IVF if other methods fail
Monitoring ovulation through temperature charts, ovulation predictor kits, or ultrasound can help diagnose these disorders more accurately.
4. Age and Declining Egg Quality
A woman’s fertility naturally declines with age. By the mid-30s, both the quantity and quality of eggs decrease significantly, and the risk of miscarriage increases.
Why Age Matters:
Ageing affects the genetic quality of eggs, making chromosomal abnormalities more likely. The ovarian reserve — or number of viable eggs — also diminishes, reducing the chance of natural conception.
Signs of Age-Related Infertility:
- Irregular periods or shorter cycles
- Difficulty conceiving after 6–12 months of trying
- Increased risk of miscarriage
Treatment Options:
- Fertility preservation (egg freezing in your 20s or early 30s)
- IVF with own or donor eggs
- Hormone testing to assess ovarian reserve (AMH, FSH, etc.)
Women over 35 trying to conceive should consult a fertility specialist after six months of unprotected intercourse.
5. Blocked or Damaged Fallopian Tubes
The fallopian tubes play a crucial role in natural conception by transporting the egg from the ovary to the uterus. If the tubes are blocked or damaged, fertilisation cannot occur.
Causes of Tubal Blockage:
- Pelvic Inflammatory Disease (PID)
- Sexually transmitted infections like chlamydia or gonorrhoea
- Previous ectopic pregnancies
- Pelvic or abdominal surgery
Symptoms:
Often, there are no symptoms until infertility is investigated. In cases of chronic infection, there may be pelvic pain or irregular discharge.
Diagnosis and Treatment:
- Hysterosalpingography (HSG): An X-ray to check tubal blockage
- Laparoscopy: Minimally invasive surgery for visual confirmation
- Surgical repair: In mild cases of damage
- IVF: Often recommended when both tubes are blocked
IVF bypasses the need for fallopian tubes entirely, making it a viable option for many women with tubal infertility.
Additional Factors That May Contribute to Female Infertility
- Uterine abnormalities: Fibroids, polyps, or congenital defects
- Autoimmune disorders: Conditions like lupus may interfere with implantation
- Lifestyle choices: Smoking, alcohol, extreme dieting, or stress
- Obesity or being underweight: Both extremes can affect hormone production
It’s important to look at infertility as a complex issue with multiple layers. Sometimes, no clear cause is found, leading to a diagnosis of unexplained infertility.
When to See a Fertility Specialist
Consider consulting a fertility expert if:
- You’re under 35 and haven’t conceived after 12 months of unprotected intercourse
- You’re over 35 and haven’t conceived after 6 months
- You have a known condition like PCOS, endometriosis, or thyroid disorder
- Your menstrual cycles are irregular or absent
Early intervention can improve treatment outcomes and offer peace of mind.
Conclusion
Female infertility can stem from various causes — hormonal imbalances, age, structural problems, or underlying conditions like PCOS and endometriosis. Identifying the root cause is key to receiving the most effective treatment.
Fortunately, advancements in reproductive medicine now offer many options, from medication to IVF and fertility preservation. By seeking timely help and understanding your body, you take the first step towards informed, empowered fertility care.
To learn more, explore our articles on how to manage PCOD and risks of infertility after abortion.
FAQs
What is the most common cause of female infertility?
Polycystic Ovary Syndrome (PCOS) is one of the most common causes, affecting hormonal balance and ovulation.
Can infertility in women be treated?
Yes, many causes of female infertility can be treated with medications, lifestyle changes, or assisted reproductive technologies like IVF.
Does age affect fertility?
Yes, fertility declines after age 35 due to reduced egg quality and quantity.
Is it possible to get pregnant with blocked fallopian tubes?
Natural conception is unlikely, but IVF can help bypass the fallopian tubes and result in pregnancy.
What tests diagnose female infertility?
Hormone tests, pelvic ultrasound, HSG, ovulation tracking, and laparoscopy are commonly used.
