What are the signs of female infertility, and when should I get tested?
Infertility is generally defined as the inability to conceive after 12 months of unprotected intercourse, or 6 months for women over 35. Some women notice signs that prompt them to seek an evaluation earlier, such as a pattern of irregular or absent periods, unusually painful cycles, or a history of miscarriage. However, many causes of infertility do not produce noticeable symptoms, meaning some women may not know there is an issue until they begin trying to get pregnant.
Testing is not limited to those who meet the clinical definition of infertility. Women who are planning ahead, have known risk factors, or simply want a better understanding of their fertility can pursue a fertility evaluation.
Possible Causes of Female Infertility
Female fertility is multifaceted, meaning there is a wide range of medical, hormonal, and structural factors that can impact a woman’s ability to conceive. Some of the most common causes of female infertility include:
- Polyendocrine Metabolic Ovarian Syndrome (PMOS; formerly known as Polycystic Ovary Syndrome, or 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
In some cases, more than one factor may be involved, which is why fertility testing at Pacific Fertility Center is comprehensive.
What is AMH testing and why does it matter?
AMH testing is a simple blood test that measures your levels of Anti-Müllerian Hormone (AMH), a hormone produced by small sacs in the ovaries that contain developing eggs. AMH levels tend to be proportional to the number of eggs you have left, which is known as the ovarian reserve. This means higher levels of AMH generally suggest a larger egg supply, while lower levels may indicate diminished ovarian reserve. AMH levels naturally decline with age, though the rate varies from person to person. It's also worth noting that AMH testing does not measure the quality of the eggs that are left or predict your chances of conceiving naturally. Instead, it serves as one part of a broader evaluation, helping fertility specialists understand how your ovaries are likely to respond to treatment, so they can tailor recommendations accordingly.
What other female fertility testing is part of an overall evaluation?
At Pacific Fertility Center, we use a combination of diagnostic tools to assess all aspects of your fertility, such as ovulation, hormone function, and reproductive anatomy. Your provider will recommend appropriate tests based on your symptoms, medical history, and family building goals.
Medical History and Physical Examination
Every evaluation starts with a thorough review of your medical and reproductive history, which may include questions about your menstrual patterns, past pregnancies, prior diagnoses, surgeries, medications, family history, and lifestyle. Your specialist will also conduct a physical exam to assess reproductive anatomy and identify any visible concerns.
Ovulation Assessment
Regular, predictable ovulation is essential for natural conception. If ovulation is irregular, infrequent, or absent altogether, it can significantly affect the ability to conceive. To evaluate whether ovulation is occurring consistently, our team may use a combination of cycle tracking, progesterone level testing, and ultrasound monitoring.
Hormonal Testing
When reproductive hormones are out of balance, it can affect ovulation, the health of your uterine lining, and your overall ability to conceive. Blood tests measuring follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, and thyroid hormones help identify where those imbalances may be occurring and what they mean for your fertility and treatment plan.
Ovarian Reserve Testing
Ovarian reserve refers to the number of eggs remaining in the ovaries. In addition to AMH testing, our team measures egg supply using antral follicle count (AFC) — an ultrasound-based assessment that counts the small, developing follicles visible in the ovaries at the start of a cycle.
Hysterosalpingography (HSG)
A hysterosalpingography (HSG) is an imaging exam used to evaluate the fallopian tubes and the shape of the uterus. During the procedure, a contrast dye is introduced through the cervix, and X-ray images are taken to track how the dye moves through the reproductive tract. This allows providers to identify whether the fallopian tubes are open or blocked and to detect abnormalities in uterine shape, both of which could interfere with conception or implantation.
Transvaginal Ultrasound Testing
Transvaginal ultrasound provides detailed imaging of the uterus and ovaries. During the exam, a small ultrasound probe is gently inserted into the vagina, allowing for a closer, more precise view of the reproductive organs. This type of imaging is used to monitor follicle development and identify any abnormalities such as fibroids or cysts.
Laparoscopy
Laparoscopy is a minimally invasive surgical procedure that may be used when standard testing has not fully explained a patient's fertility challenges. It involves inserting a small camera through tiny incisions in the abdomen to provide specialists with a direct view of the pelvic organs. This can help providers identify pelvic adhesions and definitively diagnose conditions such as endometriosis.
Genetic Testing
Genetic testing may be recommended when there is a personal or family history of inherited conditions or findings that suggest there may be genetic factors impacting fertility or pregnancy outcomes.
Saline Infusion Sonogram (SIS)
A saline infusion sonogram (SIS) is an imaging technique that uses saline solution and ultrasound to provide a detailed image of the uterine cavity. A small amount of saline is introduced into the uterine cavity, which causes it to expand, helping providers visualize subtle abnormalities such as polyps, fibroids, or scar tissue.
