Female factor infertility
Female factor infertility means that a cause in the woman is the main or a contributing reason a couple has not conceived. The causes fall into a few groups: ovulation, the fallopian tubes, the uterus, ovarian reserve and age. At EVE Women and Fertility Clinic in Gunjur, Bangalore, Dr. Swati Shree finds which of these apply, so treatment targets the actual cause. This page explains the causes. The tests and the visit are described under Fertility evaluation.
At a glance
- Main causes
ovulation problems, tubal damage, uterine problems, endometriosis, reduced ovarian reserve, age
- Contributing share
in about one-third of couples the main cause is in the woman, one-third in the man, and the rest in both or unexplained
- Common, treatable causes
PCOS, thyroid problems, high prolactin, blocked tubes
- Age
egg number and quality fall with age, faster after 35
The main causes
1. Ovulation problems. If the egg is not released regularly, conception is difficult. Causes include PCOS, thyroid disease, high prolactin, extreme weight loss or gain, intense exercise, and early ovarian insufficiency. These are often treatable.
2. Tubal factor. The fallopian tubes carry the egg and are where sperm and egg meet. Past pelvic infection, tuberculosis, endometriosis, surgery, a previous ectopic pregnancy or adhesions can block or damage them. This is a common cause in India, where genital tuberculosis is a recognised cause.
3. Uterine factor. Fibroids that distort the cavity, polyps, a uterine septum, adhesions after infection or surgery (Asherman syndrome), and a thin lining can interfere with implantation.
4. Endometriosis and adenomyosis. Both can affect tubes, eggs, and the lining. See their pages.
5. Ovarian reserve and age. The number and quality of eggs decline over time. AMH and antral follicle count estimate the number, but only age reflects quality. See Low ovarian reserve.
6. Cervical factor. Rarely, problems with cervical mucus or past cervical surgery.
7. Other factors: medical conditions such as diabetes, autoimmune disease, some medicines, smoking, alcohol, and very high or low body weight.
Symptoms that point to a cause
| Symptom | May point to |
|---|---|
| Irregular or absent periods | Ovulation problem, PCOS, thyroid, prolactin |
| Painful periods, pain during sex | Endometriosis, adenomyosis |
| Heavy periods | Fibroids, polyps, adenomyosis |
| Past pelvic infection or surgery | Tubal factor |
| Regular periods with no symptoms | Many causes, including unexplained |
Many women with infertility have no symptoms at all, which is why testing matters.
What happens at EVE
Dr. Swati begins with a long consultation, an examination and scan. She plans tests for ovulation, reserve, tubes and uterus, and the male partner's semen analysis. You then receive a clear explanation and plan. See Fertility evaluation for the full sequence.
Treatment depends on the cause
| Cause | Possible approach |
|---|---|
| Ovulation problem | Treat the cause, ovulation induction with monitoring |
| Mild tubal damage, one open tube | Timed attempts or IUI |
| Blocked tubes | IVF, or surgery in selected cases |
| Uterine polyp, septum or fibroid | Hysteroscopic or other surgical correction |
| Endometriosis | Medical or surgical treatment, then fertility planning |
| Low reserve, older age | Earlier IVF, discussion of egg freezing where appropriate |
| Unexplained | Timed attempts, IUI, then IVF |
When to see a doctor
See a specialist after 12 months of trying, 6 months if you are 35 or older, or sooner with irregular cycles, known endometriosis or fibroids, pelvic infection or surgery, or after two or more miscarriages.
FAQs
What is the most common cause of female infertility?
Ovulation problems are among the most common, with PCOS the most common cause. Tubal damage and endometriosis are also frequent, and age-related decline is a key factor after 35. Often more than one factor is present, so a full evaluation matters.
Can a woman be infertile with regular periods?
Yes. Regular periods suggest ovulation is likely, but they do not show whether tubes are open, the uterus is healthy, or the eggs are of good quality. A fertility evaluation looks at these.
Does age affect fertility in women?
Yes. Fertility declines gradually from the late twenties, and more steeply after 35, because egg number and quality fall. The chance of miscarriage also rises with age. This is why older women are advised to seek help after 6 months of trying.
Can blocked fallopian tubes be treated?
Some can, with surgery, when damage is mild. For many women with blocked tubes, IVF is advised because it bypasses the tubes. If one tube is open, timed attempts or IUI may still work. Dr. Swati explains which suits your findings.
Does genital tuberculosis cause infertility?
It can. Genital TB may damage the tubes and uterine lining, and it can be present without obvious symptoms. It is considered when tests suggest it, especially with tubal damage or a thin lining. It is treatable with the right medicines.
Can lifestyle changes improve female fertility?
They can help. Quitting smoking, limiting alcohol, achieving a healthy weight, and managing thyroid and diabetes support ovulation and general fertility. They do not replace treatment for blocked tubes or very low reserve, but improving them gives treatment a better chance.
Sources
- ASRM Practice Committee, Definition of infertility (2023); Evaluation of the infertile female (2015)
- ESHRE Guideline: Unexplained infertility (2023)
- NICE Guideline CG156: Fertility problems
