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Blog > Testing infertility in women: signs, causes and symptoms

Testing infertility in women: signs, causes and symptoms

Considering fertility testing for the first time can be overwhelming, but there are plenty of reasons for doing it. Many face hurdles on the path to parenthood, and seek clarity on issues that are making conception harder. Others know that they have preexisting conditions, and would like guidance on whether they are likely to impact fertility. Some feel empowered to test to get an idea of their fertility options down the road.

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Written by Giulia Sciota

People might also test their fertility ahead of treatment that could impact it, such as chemotherapy or gender-affirming surgery. A clearer picture of a person’s current fertility can guide the decision around fertility preservation.

The good news is that science has come a long way, making it possible to diagnose and treat many of the underlying causes for infertility. In this guide, we aim to walk you through the ways that infertility affects women, how to test if a woman is infertile, and the medical advice often given to treat infertility.

Understanding fertility in women

Infertility is generally defined as the difficulty to conceive after 12 months or more of regular unprotected sex. Although infertility can be lonely, it’s surprisingly common: the Fertility Network estimates that one in six couples are affected.

What can cause infertility in women?

Fertility problems can affect men and women in different ways. In women, problems with ovulation are the most common cause of infertility. When ovulation – or the release of a mature egg from the ovary – is affected, pregnancy becomes difficult, because of the crucial role it plays in conception.

Again, ovulatory issues are more common than people realise. They include:

Polycystic ovarian syndrome (PCOS), a hormonal disorder which affects around one in 10 women in the UK. PCOS is characterised by altered levels of certain hormones which are known to alter or prevent ovulation.
Premature ovarian insufficiency (POI), when a person’s ovaries begin to release eggs inconsistently and stop producing adequate levels of hormones.
Thyroid disorders. Thyroid hormones play a crucial role in regulating the menstrual cycle and ovulation, so an irregular level may lead to irregular or absent ovulation.

Infertility does not always have one main cause. For example, hormonal imbalances can also cause a woman to be infertile, due to their effect on ovulation. This is why hormones are so often tested in fertility assessments for women.

Other conditions that affect fertility in women include:

Endometriosis, where cells similar to those located in the womb's lining grow in other places of the body.
Fibroids, noncancerous growths that develop within or on the walls of the uterus which can impact fertility (depending on size, location and the symptoms they cause).
Blockages in the fallopian tubes, which carry the egg from the ovary to the uterus for fertilisation.
Pelvic inflammatory disease (PID), an infection usually caused by a sexually transmitted infection (STI), which can damage or scar the fallopian tubes.

Chemotherapy, alongside certain medications and surgeries can also affect fertility. Lifestyle factors such as how much you weigh, drink and smoke, are also known to have a considerable impact.

If you’re interested in learning just how much lifestyle factors can affect your fertility, visit our natural fertility predictor.

Signs of infertility in woman

Infertility can be difficult to diagnose based on symptoms alone. While the main indicator is the inability to get pregnant, there are other signs and symptoms of infertility in women that may suggest you have an underlying issue that is contributing to your struggles to conceive.

Irregular menstrual cycles: Having irregular, infrequent (more than 35 days apart), or absent periods (amenorrhea) can indicate problems with ovulation, as can cycles that are consistently shorter than 21 days or longer than 35 days.
Heavy or painful periods: Heavy periods (menorrhagia) or severe cramps can be a sign of conditions like uterine fibroids, polyps, endometriosis, or other reproductive health issues.
No ovulation symptoms: A lack of ovulation signs like mid-cycle cervical mucus changes or a slight increase in basal body temperature may indicate you aren’t ovulating which is a common cause of infertility.
Pelvic pain: Pain during menstruation, intercourse, or at other time may point to endometriosis, pelvic inflammatory disease (PID), or other reproductive issues.
Hormonal imbalances: Symptoms like acne, excessive hair growth, or weight changes can be indicative of PCOS or thyroid issues which can impact fertility.
Recurrent miscarriage: While one miscarriage is common, recurrent miscarriages (two or more) may signal underlying fertility issues.

How do you know if you can't get pregnant?

Not falling pregnant quickly after you begin trying to conceive isn’t always an indicator of underlying fertility issues. Even healthy, fertile women only have a 15-25% chance of conceiving each month as the timing of intercourse must align with ovulation. In addition, sperm and egg quality, and the uterine environment all must be optimal to create a viable embryo that implants successfully in the womb.

However, if you have been having regular intercourse for a year or more and have yet to fall pregnant, this may suggest there is something impacting your fertility. The only way to confirm this is through fertility testing.

If you’ve been diagnosed with a reproductive health condition such as endometriosis or blocked fallopian tubes, you may already be away that your chances of natural conception are affected. This doesn’t necessarily mean you cannot fall pregnant, but knowing this information may mean you wish to explore fertility treatment options after a shorter period of trying to conceive.

How can a woman tell if she is infertile?

The main sign of infertility is an inability to get pregnant after a year of trying to if you’re under 35, or after six months if over 35. However, causes of infertility don’t always produce symptoms and unfortunately, some infertility is unexplained. The only way to gain a more thorough understanding of your reproductive health is to undergo fertility testing and discuss the results with a fertility specialist.

How to test if a woman is infertile

If you’re worried about testing for infertility, know you’re not alone. Advancements in medical science have made it possible to diagnose and treat many of the underlying causes of infertility in women. Consulting a fertility specialist can be a great first step, as a person’s medical background, fertility history, previous contraception, and family planning goals may influence the values tested.

In a basic fertility assessment, we tend to look at:

Ovarian reserve: a blood test which measures anti-Müllerian hormone (AMH), a value that indicates the quantity of eggs you have.

Thyroid profile: a blood test which assesses thyroid function.

Ultrasound scan: to check your ovaries, womb and fallopian tubes.

These values help us to get a good idea of a woman’s fertility and advise on next steps. All of our fertility assessments include a consultation with a fertility specialist to explain your results.

For the AMH test and thyroid value, we’ll send you a clinical-grade blood test which you can do at home (or if you prefer, at a clinic near you). For your ultrasound scan, you can choose a scanning centre close to home, thanks to our network of ultrasound partners all over the country. If you live in London, we can even offer you an ultrasound scan at home.

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A more specialised assessment might involve one of the following:

STI: a home blood testing kit or a swab at a clinic make STIs one of the quickest and easiest conditions to check for.

Hysterosalpingo contrast sonography (HyCoSy): a special X-ray which assesses your fallopian tubes with a special dye.

Laparoscopy: also known as keyhole surgery, a laparoscopy involves making a small incision in your lower stomach in order to examine your ovaries, womb and fallopian tubes and ovaries. A laparoscopy may be used to investigate endometriosis, or following pelvic inflammatory disease (PID).

Additional hormones: as hormones are so closely linked to fertility, additional hormone tests are common. Fertility specialists may want to assess levels of hormones like luteinizing hormone (LH), follicle-stimulating hormone (FSH), progesterone and/or gonadotropins.

Genetic testing: if a specialist believes that there is a genetic cause of infertility, they may recommend genetic testing.

Treating infertility in women

The good news is that there are plenty of options available to treat infertility in women. Once the cause of infertility is identified, a fertility specialist will discuss potential options tailored to your unique situation.

These options may include:

Medications such as Clomid or letrozole, which can help regulate ovulation and increase chances of conception.
Assisted reproductive treatment (ART) such as intrauterine insemination (IUI) and in vitro fertilisation (IVF) can assist pregnancy by facilitating the fertilisation process.

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Surgery, if there is a structural abnormality hindering conception.

Donor eggs are also an option when a woman’s own eggs are not seen as likely to result in pregnancy.

How do women deal with infertility?

It’s worth remembering that the journey towards understanding and treating infertility is known to be a difficult one. It’s not uncommon to experience hard emotions and ups and downs. 25-60% of infertile individuals report experiencing depression and anxiety because of their diagnosis.

Seeking support in addition to medical guidance has tremendously helped many individuals struggling with infertility. We offer complimentary fertility counselling within all of our treatment packages, alongside standalone fertility counselling.

You may also find it helpful to connect with groups, counsellors and therapists who specialise in fertility-related issues. There are plenty of online and offline communities designed to provide you with the tools necessary to feel supported and informed along the journey.

When should you speak to someone?

The NHS advises that people who have been trying to conceive for more than one year should get in touch with their doctor or a fertility specialist. Guidance suggests that women over 35 should seek help sooner, due to the link between age and infertility.

With Apricity, fertility assessments are available to you at any time, regardless of where you are on your journey. Fertility tests are less invasive and expensive than fertility treatment, and a good starting point to understand the options available for the present or future.

If you would like to discuss fertility assessments with an advisor, there are several ways to get in touch: