Infertility is medically defined as the inability to achieve pregnancy after 12 months of regular, unprotected sexual intercourse, or after 6 months if the woman is 35 years or older.
For women, a wide range of factors can cause infertility, some hormonal, some structural, and others lifestyle-related.
Understanding these causes is the first step toward proper diagnosis, treatment, and reassurance.
In this article, we’ll go straight into the most common reasons why women struggle to conceive.
Ovulatory Disorders
When ovulation does not occur regularly or at all, it becomes difficult to predict fertile windows or achieve pregnancy.
The major culprits include:
a. Polycystic Ovary Syndrome (PCOS)
Women with PCOS often experience irregular periods, excess male hormones, and multiple small cysts in the ovaries. PCOS disrupts egg maturation and release.
Both overactive and underactive thyroid can interfere with ovulation.
Elevated prolactin (hyperprolactinemia) also suppresses reproductive hormones, leading to irregular cycles and infertility.
c. Functional Hypothalamic Anovulation
High stress, sudden weight loss or gain, and intense exercise can confuse the brain’s hormone signals and stop ovulation. It’s often seen in women who are underweight or very physically active.
When ovulation is irregular, simple tests such as tracking menstrual cycles, hormone blood tests, or ultrasound monitoring can help pinpoint the problem and guide treatment.
Tubal Factor & Pelvic Inflammatory Disease (PID)
PID can cause scarring and adhesions inside the tubes, leading to infertility or ectopic pregnancy.
Other risk factors for tubal damage include:
Screening and early treatment of STIs significantly reduce the risk of PID-related infertility.
Endometriosis
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, often on the ovaries, fallopian tubes, or pelvic walls.
Endometriosis contributes to infertility in several ways:
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Inflammation: Creates a hostile environment for sperm, egg, and embryo.
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Anatomical distortion: Adhesions and scar tissue may block tubes or trap the ovary.
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Women with endometriosis often report painful periods, pelvic pain, or pain during sex, but it can also be silent.
Diagnosis typically requires a laparoscopy, although imaging can be helpful in some cases.
Management may involve surgery to remove lesions, fertility treatments like IVF, or a combination, depending on severity and age.
Age-Related Decline & Diminished Ovarian Reserve
A woman’s fertility is closely tied to age. Natural fertility begins to decline in the early 30s and drops more sharply after age 37. By the early 40s, the chances of natural conception each month are very low.
The decline happens because:
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Egg quantity decreases: Women are born with all the eggs they will ever have, and the supply diminishes over time.
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Egg quality worsens: Older eggs are more likely to have chromosomal abnormalities, reducing the chances of fertilization, implantation, and a healthy pregnancy.
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Diminished Ovarian Reserve (DOR) refers to a lower-than-expected egg supply for a woman’s age. It does not always mean infertility, but it can reduce the effectiveness of fertility treatments. Tests such as AMH (Anti-Müllerian Hormone), FSH levels, and antral follicle count (AFC) help estimate ovarian reserve.
Because age is such a strong factor, experts recommend seeking a fertility evaluation after 6 months of trying if a woman is 35 or older.
Uterine & Cervical Factors
Problems within the uterus or cervix can interfere with implantation or sperm passage, contributing to infertility. These causes are less common than ovulatory or tubal issues but remain significant.
Uterine factors include:
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Fibroids (leiomyomas): Especially submucosal fibroids, which distort the uterine cavity and hinder implantation.
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Endometrial polyps: Small, noncancerous growths in the uterine lining that can make it harder for an embryo to implant.
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Cervical factors include:
Most uterine and cervical causes can be detected with imaging (ultrasound, hysteroscopy, hysterosalpingography) and are often treatable, improving chances of conception.
Lifestyle & Systemic Contributors
Certain lifestyle habits and medical conditions can reduce fertility even when the reproductive organs are structurally normal. These factors often worsen existing infertility causes or make treatment less effective.
Key contributors include:
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Excess weight (obesity or underweight): Both extremes disrupt normal ovulation and hormone balance.
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Smoking: Accelerates loss of eggs, lowers ovarian reserve, and increases miscarriage risk.
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Alcohol & substance use: Linked to poorer fertility outcomes.
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Chronic illnesses: Poorly controlled diabetes, autoimmune diseases, and untreated thyroid disorders may impair fertility.
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Environmental exposures: Prolonged exposure to pesticides, industrial chemicals, and radiation may reduce reproductive health.
The good news is that many of these factors are modifiable.
Optimizing weight, stopping smoking, limiting alcohol, and managing chronic illnesses can significantly improve fertility outcomes, both naturally and during assisted reproduction.
Unexplained Infertility
It doesn’t mean nothing is wrong, but rather that current testing cannot pinpoint the cause.
Conclusion
Facing infertility isn’t easy, and it often comes with more questions than answers. But with the proper guidance and timely support, many women do find a path forward.
Every journey is different, and sometimes just talking about it can make the load feel lighter.
I’d really like to know what you think about this topic. Your thoughts or even questions could help shape the conversation further.
Drop it in the comment section!
Researched by Victoria Odueso
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