What are the signs of female infertility, and when should I get tested?
If you’ve been trying to conceive for at least 12 months, or at least six months if you’re over age 35, it’s a good idea to set up an appointment with a fertility specialist, who can recommend appropriate testing to help pin down any potential causes and recommend treatment options.
Even if you’re not currently trying to conceive, testing is also recommended if you’re considering egg or embryo freezing, have specific concerns or risk factors, or may be undergoing medical treatments—such as chemotherapy or gender-affirming care—that can affect fertility.
Some women with infertility experience noticeable symptoms, such as irregular, very painful, very heavy, or absent periods. Fertility testing is also recommended if you have a family history of early menopause, or a history of miscarriages or sexually transmitted infections (STIs). Some women, however, experience no signs or symptoms of infertility. No matter where you are in your fertility or family-building journey, testing can help you understand your options as you plan for the future.
Possible Causes of Female Infertility
Female infertility can be caused by a wide range of factors. While many cases of infertility are able to be diagnosed, some remain unexplained.
Some of the most common causes of female infertility include:
Ovulation disorders
- Age-related decline in egg quality and quantity
- Polycystic ovary syndrome (PCOS)
- Primary ovarian insufficiency (POI)
- Hormonal imbalances
- Irregular or absent ovulation
Structural abnormalities
- Endometriosis
- Uterine fibroids, polyps, or cysts
- Fallopian tube damage or blockage
- Pelvic adhesions or scarring
Other medical conditions
- Pituitary tumors
- Pelvic inflammatory disease (PID)
- Recurrent pregnancy loss
- Genetic or chromosomal conditions
Lifestyle factors
- Smoking
- Obesity
- Excessive alcohol or drug use
What is AMH testing, and why does it matter?
Anti-müllerian hormone (AMH) testing often plays an important role in female fertility testing. This simple blood test measures levels of AMH hormone, a protein produced by the small follicles in the ovaries. This helps determine your ovarian reserve, or the estimated number of eggs remaining in the ovaries. A higher level of AMH corresponds with a bigger egg reserve, while a lower level of AMH typically corresponds to a smaller egg reserve.
This information can be very helpful in assessing overall fertility and reproductive potential, allowing doctors to recommend the best treatment for your individual situation. AMH testing is often done before IVF to determine the ideal medications and dosages for each patient. Keep in mind, however, that while AMH testing can provide insight into the quantity of eggs remaining, it cannot provide information on the quality of those eggs.
At PCRM, we have years of experience conducting AMH testing, often in combination with other tests and evaluations, including physical exams and ultrasounds. Our caring team will guide you through each step of the process and lay out a personalized treatment plan to address your unique needs.
What other female fertility testing is part of an overall evaluation?
Aside from AMH testing, several other tests and assessments may be done to fully assess female fertility and guide appropriate treatments. Some of the most common tests include:
Medical History and Physical Examination
A thorough physical examination will help your doctor determine whether any physical, anatomical, or structural issues may be impacting fertility. This usually includes a pelvic exam, which is very similar to a standard annual exam at your gynecologist. Depending on your individual circumstances, other tests may be required to gain more information. A comprehensive review of your medical history and family medical history—as well as those of your partner’s, if applicable—will also help provide insight into your fertility and reproductive health.
Ovulation Assessment
Typically completed using hormone blood tests and in some cases, ultrasounds, ovulation assessments allow your doctor to evaluate whether you are ovulating (releasing an egg) each month, determine when it’s happening, and assess overall ovulatory health. This can also help your doctor determine the most fertile days in your menstrual cycle, when it may be easier to conceive.
Hormone Testing
Hormone testing, usually involving bloodwork and sometimes urine samples, is often done to assess levels of various hormones that may impact female fertility. Follicle stimulating hormones (FSH) and luteinizing hormones (LH), as well as prolactin, estradiol, and thyroid stimulating hormones (TSH) are often tested, all of which can affect fertility. Results can help doctors assess ovarian reserve, determine whether any conditions may be impacting fertility, evaluate ovulation, and guide treatment options.
Ovarian Reserve Testing
Ovarian reserve testing usually involves several different tests, including hormone testing, AMH testing, and antral follicle count (AFC) ultrasounds, which count the number of follicles in the ovaries in order to determine the potential for egg production. These tests measure the total number of eggs remaining in the ovaries and can help predict how well you may respond to fertility medications.
Hysterosalpingography (HSG)
An HSG is a specialized X-ray test that uses contrast dye to examine the inside of the uterus and fallopian tubes in detail. This can help doctors see whether you have blockages or scarring in the fallopian tubes, structural abnormalities of the uterus, and other issues that may be affecting fertility.
Transvaginal Ultrasound Testing
A transvaginal ultrasound is a common imaging procedure used to assess the female reproductive organs, including the uterus, fallopian tubes, cervix, ovaries, and vagina. Completed via the insertion of a lubricated probe into the vagina, transvaginal ultrasounds can provide valuable information on ovarian reserve and the thickness of the uterine lining, and also help identify any physical issues such as polyps or fibroids that could be impacting fertility.
Laparoscopy
This minimally invasive surgical procedure provides a detailed view of the uterus, ovaries, and fallopian tubes. Laparoscopy is often considered the gold standard for diagnosing conditions—such as endometriosis and fallopian tube blockages—that can’t be identified through other tests and imaging procedures.
Genetic Testing
Genetic testing may be recommended for some patients who have chromosomal or inherited conditions that may impact pregnancy outcomes and fertility. Genetic testing can also identify any conditions that could be passed on to your child and guide treatment options.
Saline Infusion Sonogram (SIS)
The minimally invasive SIS procedure uses saline fluid to help doctors visualize the uterine cavity, making it easier to identify any structural abnormalities—such as polyps, fibroids, or adhesions—that could impact fertility. An SIS also allows doctors to examine the uterine lining and help guide treatment recommendations.
