You’ve probably spent a decent chunk of your life trying to avoid pregnancy, but now you’re ready to have a baby and…so far, it’s been a big fat nothing. Figures, right? Your best friend and sister-in-law both got pregnant on the first try, but you’re six months in and still not getting any positive lines on those drugstore pregnancy tests (which we know are not cheap, BTW).
Do you just have really bad timing in the baby-making department, or could there actually be something wrong? And if there is something wrong, does that mean you can’t ever get pregnant? Before you start panicking, hear us out.
First of all, you’re DEFINITELY not alone
Before jumping into the symptoms and signs, let’s pause and take a collective deep breath (like, your best end-of-yoga-class deep breath). If you do run into fertility issues, know that you’re joining a not-so-exclusive club.
According to RESOLVE, The National Infertility Association, one in eight couples in the U.S. suffer from infertility in one way or another. But what does “infertility” actually mean?
“We use an infertility diagnosis when a couple of reproductive age has been attempting to conceive for a year or more without success,” says Dr. Anthony Propst, reproductive endocrinologist at Texas Fertility Center. “85% of couples of reproductive age will get pregnant [naturally] in a one-year timeframe.”
Dr. Propst notes there’s a 50/50 split between male and female infertility as the cause, and sometimes, it’s a combo of the two. But while an infertility diagnosis sucks, it’s definitely not the end of the road. You’re going to keep moving towards your goal of having a child, but your path there may not be quite as direct as you’d imagined. Whatever path you follow, educating and empowering yourself is going to be the first step. So, let’s dive in, shall we?
Signs and symptoms of female infertility
First things first: if you have been trying to conceive for a year and it hasn’t happened yet, it’s time to schedule a visit with your doctor so he or she can start figuring out why. But! There are exceptions to the one-year rule: Dr. Propst says that if you’re not having regular menstrual cycles, you may not want to wait 12 months before you make that call.
“If you’re having irregular periods or going months between cycles, you’re probably not ovulating [normally] and it doesn’t make sense to wait a year for treatment,” says Dr. Propst.
He notes that there are a few risk factors for infertility, so if you meet any of the following criteria you can also cut to the front of the line:
- You have a history of pelvic infections or STDs, especially chlamydia or gonorrhea;
- You have a history of endometriosis or pelvic surgery;
- You are over the age of 35.
Common causes of female infertility
According to Dr. Mark Trolice, infertility specialist at Fertility CARE: The IVF Center in Florida, about 40% of female fertility problems are related to ovulation and 40% are related to tubal disorders.
The rest (20% if you’re doing the math, smartypants) comes down to uterine conditions and, sometimes, unknown reasons. Here’s a breakdown of the biggest causes of female infertility.
Ovulation problems and ovarian conditions
- Polycystic Ovarian Syndrome (PCOS): A hormonal condition that can cause irregular periods, excessive levels of male hormones, and enlarged ovarian follicles.
- Early menopause: When your ovaries stop producing hormones (meaning you stop getting a monthly period) before the age of 40, this is called early or premature menopause.
- Thyroid dysfunction: An umbrella term for a bunch of different conditions that may be caused by your thyroid not functioning correctly (like making too much or not enough thyroid hormones).
- Hypothalamic amenorrhea: This is sometimes caused by an energy imbalance in patients who may be over-exercising or not eating enough; it’s common in female athletes, as well as women who have eating disorders or high levels of emotional stress. According to the U.S. National Library of Medicine, this can negatively not only affect your reproductive system, but your skeletal and cardiovascular ones, too.
- Diminished ovarian reserve (DOR): This basically refers to having a diminished number of eggs. Your eggs start declining naturally with age, but Dr. Paula Brady, fertility specialist at Columbia University Fertility Center, says autoimmune conditions, genetic predispositions, and radiation or chemotherapy treatments for cancer can also reduce your number of eggs. Low ovarian reserve can actually reduce the quality of your eggs, too, which could make the fertilization and implantation of a healthy embryo even harder (and according to Southern California Reproductive Center, may contribute to a higher risk of chromosomal abnormalities, which can lead to early miscarriage).
- Endometriosis: This is a chronic pain condition that causes uterine tissue to grow on your other organs, like the ones in your abdomen or pelvis. Scarring can cause 30-50% of patients with endometriosis to experience infertility, and while some endometriosis scarring can be removed with surgery, Dr. Brady warns that surgery can create as many problems as it tries to fix, potentially diminishing ovarian reserve or causing further scarring or complications.
As far as treatments go, the vast majority of ovulation problems are treated with medication, since the problems are hormonal, not anatomical. This might include pills or injections to stimulate the ovaries.
If your fertility struggles are related to your fallopian tubes, the actual problem will lie in 1 of 2 places: at the part of the tubes closest to your uterus or at the ends of your tubes. Your doc will need to detect the location of your tubal issues, because it’ll help determine your next steps.
- Tubal abnormalities near your uterus: This is usually caused by blockages—either mucus plugs or scarring and inflammation—that, according to Dr. Propst, can sometimes be treated with an outpatient procedure to open up the tubes.
- Abnormalities at the end of your fallopian tubes: This type of damage is usually caused by pelvic infections or previous STDs like chlamydia and gonorrhea. These infections can cause scarring, swelling, and a back-up of fluid in the tubes, all of which can affect the success rate of any treatments you try. Sometimes the damaged tubes can be surgically repaired, but sometimes it’s better to just have the tubes removed to increase your future chances of pregnancy.
With both types of fallopian tube damage, you probably won’t have any symptoms, but Dr. Propst says some women have mild pain and watery discharge if there’s a backup of fluid in the tubes.
The most common uterine conditions that may affect your fertility are endometriosis and fibroids.
- Fibroids: These benign muscular growths in the uterus are actually fairly common. They don’t always affect a woman’s fertility, but Dr. Propst says that some fibroids can interfere with implantation of a fertilized embryo, depending on where they’re located. Fibroids can be surgically removed, but not every case of uterine fibroids requires treatment.
- Asherman’s Syndrome: A condition where scar tissue develops in the uterus and sticks together, often shrinking the size of the uterus and making it hard to get pregnant. This is considered a rare disease, but if you’ve ever had uterine surgery before—especially a dilation and curettage (D&C) after a miscarriage—your risk increases. About 20% of women who have D&Cs develop uterine adhesions, according to the Cleveland Clinic. Symptoms include having light or no periods, pain and cramping, and trouble conceiving.
- Adenomyosis: A condition where endometrial tissue grows into the muscle of the uterine wall, causing the uterus to enlarge. You might have pain and pressure in your pelvic area and heavy menstrual bleeding. The Mayo Clinic says you’re particularly at risk if you’re in your 40s or 50s, have had a Csection or other uterine surgery, or have given birth.
- Common anomalies: There are several different ways for a uterus to develop abnormally, most of them revolving around the uterus splitting into two separate endometrial cavities or halves (or having a uterus that’s only partially developed). This can cause irregular menstruation, recurrent miscarriages, or pregnancy complications, though some cause no problems at all. A 2011 Ultrasound in Obstetrics & Gynecology study suggests that the type of anomaly determines whether fertility might be affected (and how much). Most anomalies will be spotted during fertility treatments, and some may be corrected with surgery to improve pregnancy outcomes.
Unfortunately, some cases of infertility don’t have a clear explanation. As weird as it sounds, your doctor can give you a diagnosis that’s pretty much the medical equivalent of the “shrugging” emoji—as in, she’s just as clueless as you are about why you’re struggling.
But Dr. Brady says that just because your doctor doesn’t find a reason doesn’t mean there isn’t one; with treatment, unexplained infertility may not stay unexplained forever. Sometimes, going ahead with IVF can be both diagnostic and therapeutic, and can reveal exactly what the problem is once and for all.
If you think you might have female infertility, it never hurts to get in touch with your OB/GYN or find a reproductive endocrinologist. They’re the experts, and they’ll either reassure you that everything is normal or give you whatever you need to deal with what comes next.