It’s natural to be curious about all the different realities you may encounter during your trying-to-conceive journey. The deeper you get into trying to grow your family, the more you end up learning. Should you be on that path for a year or longer, your next round of questions may all come back to a single umbrella question — what is female infertility, and what causes it? 

Dr. Michael Guarnaccia, the Medical Director at Pinnacle Fertility of New York, answered some of our big questions about female infertility, including some of the lead causes and how they are typically treated. 

But before we dive into those, here’s your reminder that struggling to conceive isn’t a rare occurrence; it’s actually more common than most people think. According to the CDC, about 1 in 5 women are unable to get pregnant after one year of trying, while 1 in 4 women have difficulty carrying a pregnancy to term. 

Dr. Guarnaccia recommends that anyone’s first step, no matter their fertility journey, be to ask for tests that help paint a picture of their fertility health because each person’s health, ovarian reserve, and contributing factors are unique to them. 

doctor consulting with patient

Fertility tests can help inform your fertility journey and next steps

“I always advocate that women sort of take possession as much as they feel comfortable with, of their own care and be their own care advocates,” encourages Dr. Guarnaccia. 

He adds that it’s never a bad time to learn more about your reproductive health. While it’s popular for women to advocate for these tests as a preemptive measure before trying to conceive or if they’re going down the egg-freezing path, women who struggle with infertility can also benefit from learning more about their hormone levels. 

The tests offer any woman and her care team a better understanding of what her reproductive health is at that specific moment in time. Some of the tests that can help paint this picture include blood work specific to your ovarian reserve, AMH (anti-müllerian hormone), LH (luteinizing hormone), FSH (follicle stimulating hormone), TSH (thyroid stimulating hormone), progesterone, and estradiol. 

It’s also worth noting that ~30% of infertility can be related to a sperm issue, so it’s equally as important to conduct a semen analysis for the male partner to ascertain if the issue is with the female, male, or both. 

couple consulting with a fertility specialist

4 potential causes of female infertility: What you need to know

Once initial blood work is done and your care team has an understanding of your medical history, Dr. Guarnaccia explains that commonly there are four main causes for female infertility — ovulatory dysfunction (like PCOS), anatomic issues (like endometriosis or fibroids), age-related infertility, and unexplained infertility. 

In many cases, Dr. Guarnaccia explains, many women don’t even know they have ovulatory dysfunction or conditions like PCOS (polycystic ovarian syndrome) until they are off a form of birth control, actively trying to conceive, and realize they have irregular periods or no periods at all. The CDC shares that PCOS is one of the most common causes of infertility, affecting as many as 5 million women in the US. 

On the other hand, diagnosing anatomic issues can be possible depending on the kind of anatomic issue a person is struggling with. For instance, endometriosis, a condition where tissue grows outside of the uterus, is complex to diagnose because the only way to confirm a full diagnosis is through a surgery known as laparoscopy. 

For fibroids, Dr. Guarnaccia adds: 

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“Depending on how large the fibroids are and where they're located in the uterus, they may or may not be impacting a woman's ability to get pregnant. Sometimes, women with fibroids have heavy menstrual cycles or bleed continuously, which can affect their ability to get pregnant. Sometimes the fibroids can be so large that it can affect the ability of a fertilized embryo to implant in the uterus, so on and so forth…”

In the case of diagnosing fibroids, Dr. Guarnaccia explains that often, women will be sent for an ultrasound and or an x-ray that can help determine if the fallopian tubes are blocked or if the uterus is normally shaped. If the cause of infertility proves to be anatomical, surgery could be the next step. 

lesbian couple at a fertility counseling appointment

When describing the two latter causes of infertility — age-related and unexplained — Dr. Guarnaccia noted that the first step would still be getting a round of blood work and ultrasounds to understand the person’s baseline better. Once other factors and potential treatment routes are ruled out, this is when Dr. Guarnaccia explains that IVF, IUI, or other assisted reproductive technology may be discussed. 

“Depending on the woman's age, she's over 37 or 38 years old, she might want to progress right on to IVF,” explains Dr. Guarnaccia. “That's one of those situations where one may say IVF will be in your best interest.” 

While it may be helpful to know that there are four common causes for female infertility — ovulatory dysfunction, anatomic issues, age-related infertility, and unexplained infertility — it’s still important to meet with a care team that meets you where you are, validates your fears, and answers your questions.