What are the signs of female infertility, and when should I get tested?
Some women experience noticeable symptoms that may signal a fertility concern, such as irregular or absent menstrual cycles, very painful periods, pelvic pain, or a history of miscarriage. However, many causes of infertility are silent and may not produce obvious symptoms.
It’s typically recommended that you see a fertility specialist after 6 months of unprotected sex if you are over the age of 35 and after 12 months if you are under the age of 35. Even if you are not currently trying to conceive, early fertility testing may be helpful if you have risk factors, a history of reproductive conditions, or concerns about your ovarian reserve. Testing provides clarity and allows you to plan proactively.
Possible Causes of Female Infertility
Female infertility refers to the inability to achieve pregnancy after 12 months of regular unprotected intercourse (or 6 months if ≥35). It can result from various factors such as hormonal imbalances, ovulatory disorders, reproductive system abnormalities, or age-related issues. Testing may help identify conditions such as:
- Polyendocrine Metabolic Ovarian Syndrome (PMOS, formerly known as PCOS)
- Endometriosis
- Uterine fibroids or polyps
- Blocked fallopian tubes (tubal factor infertility)
- Primary ovarian insufficiency (POI)
- Hormonal imbalances
- Low ovarian reserve
- Irregular or absent ovulation
- Pelvic adhesions or scarring
- Genetic or chromosomal conditions
- Recurrent pregnancy loss
- Unexplained infertility
Treatment options vary depending on the underlying cause, which can be identified through various types of fertility evaluations and diagnostic procedures.
What is AMH testing, and why does it matter?
Anti-Mullerian hormone (AMH) testing is among the most common hormone tests used to evaluate female fertility. As AMH is produced in the ovaries, a normal AMH balance typically indicates normal ovarian reserve, while low AMH levels can be a sign of diminished ovarian reserve or potentially premature menopause. Measuring AMH levels is also crucial in determining how a patient may respond to ovarian stimulation medications, such as those used in in vitro fertilization (IVF).
AMH levels naturally decline with age. While AMH does not measure egg quality directly, it provides information about ovarian reserve and expected response to ovarian stimulation, and helps guide treatment planning, including IVF protocols and fertility preservation decisions.
What other female fertility testing is part of an overall evaluation?
Infertility tests include lab tests (e.g., testing blood for hormone levels), imaging tests, and minimally invasive diagnostic procedures to examine reproductive organ function. These may include:
Medical History and Physical Examination
The fertility care team gathers information about your menstrual cycle regularity, sexual history, and any previous pregnancies or miscarriages, as well as your medical history. A complete physical examination is often performed to evaluate your overall level of health.
A detailed history can uncover patterns, risk factors, and underlying health concerns that may impact fertility.
Ovulation Assessment
Evaluating ovulation involves monitoring your menstrual cycle and assessing for signs of regular ovulation, such as a slight increase in basal body temperature or the results from ovulation prediction kits. Regular menstrual cycles are often a good predictor that regular ovulation is occurring, but additional testing may be needed to confirm ovulation.
Additional testing, including progesterone levels or ultrasound monitoring, may be used when needed.
Hormonal Testing
There are several hormones that influence reproductive function, so assessing hormonal levels via blood tests often provides valuable insights into fertility issues. There are several different tests you may undergo, including those that measure the levels of hormones that influence conception, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, thyroid-stimulating hormone (TSH), prolactin, and anti-Müllerian hormone (AMH).
Ovarian Reserve Testing
This involves evaluating the quantity of eggs in your ovaries. Tests such as the antral follicle count (AFC) are conducted using ultrasound, alongside AMH and hormone testing. Ovarian reserve testing helps guide decisions about timing, treatment options, and fertility preservation.
Hysterosalpingography (HSG)
An HSG test is performed by injecting a contrast dye into the fallopian tubes and uterus, and then taking X-rays to evaluate whether there are any blockages or abnormalities. An HSG is commonly used to assess fallopian tube patency and the shape of the uterine cavity.
Transvaginal Ultrasound Testing
Using a probe inserted through the vagina, this type of ultrasound examines the ovaries and uterus to detect any cysts, fibroids, or structural abnormalities. Ultrasound imaging also allows physicians to monitor follicle development and uterine lining thickness.
Laparoscopy
Laparoscopy is a minimally invasive surgical procedure that involves the insertion of a tube with a camera through a small incision; this test is often used to diagnose endometriosis or scar tissue in the pelvic organs. This procedure is typically reserved for cases where underlying pelvic conditions are suspected.
Genetic Testing
Infertility can sometimes be caused by hereditary conditions or chromosomal abnormalities detected through genetic testing. Genetic testing can be immensely helpful in several scenarios, including for patients who have experienced recurrent miscarriages. Genetic evaluation may include carrier screening or chromosomal analysis when indicated.
Saline Infusion Sonogram (SIS)
A SIS test is performed to test for uterine deformities (e.g., polyps, fibroids or scar tissue) that could interfere with getting pregnant. The procedure involves a catheter that is inserted into the cervix to examine whether polyps, myomas, or other anomalies are present inside the uterus. Saline is injected into the uterine cavity while a transvaginal ultrasound is performed to view ultrasound images, in real-time, of the uterus. Your doctor may also test the patency of your fallopian tubes with the SIS test. If the test identifies a possible abnormality within the uterine cavity, hysteroscopy may be recommended for further evaluation or treatment.
Hysteroscopy
Hysteroscopy allows your doctor to examine the inside of the uterus using a thin, lighted scope inserted through the cervix. It may be recommended if an SIS or other testing identifies a possible uterine abnormality. Hysteroscopy can be used diagnostically to evaluate concerns such as polyps, fibroids, or scar tissue, or therapeutically to treat certain abnormalities during the procedure.
