Female infertility !

Infertility is not getting pregnant after a year of regular unprotected sex. Problems with ovulation, tubes, uterus or the partner can be the cause.

Updated 2026-11-01

Structures involved

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Why it happens

What it is

Failure to achieve a clinical pregnancy after 12 months of regular unprotected intercourse, or after 6 months in women aged 35 or older. Evaluation involves the couple, because a male factor contributes in a large share of cases.

Who gets it

According to WHO, about one in six people of reproductive age experiences infertility during their lifetime, with similar rates in high- and low-income countries. In Colombia and Latin America, tubal damage from untreated sexually transmitted infections and limited access to assisted reproduction are important issues; Colombian law (Ley 1953 de 2019) set out a public policy on infertility.

Causes

Ovulatory disorders: polycystic ovary syndrome (most common), hypothalamic amenorrhoea, hyperprolactinaemia, thyroid disease, primary ovarian insufficiency
Tubal and peritoneal factor: pelvic inflammatory disease (chlamydia, gonorrhoea), endometriosis, previous pelvic surgery, genital tuberculosis
Uterine factor: submucous fibroids, polyps, intrauterine adhesions (Asherman syndrome), congenital anomalies
Cervical factor (uncommon)
Diminished ovarian reserve with age
Unexplained infertility after a complete work-up

Risk factors

Female age over 35
History of sexually transmitted infection or pelvic inflammatory disease
Obesity or very low body weight
Smoking and heavy alcohol use
Previous abdominal or pelvic surgery, unsafe abortion or postpartum infection
Chemotherapy or pelvic radiotherapy

Pathophysiology

Conception requires ovulation of a competent oocyte, a patent tube where the oocyte meets sperm in the ampulla, transport of the embryo to the uterus, and a receptive endometrium. Hormonal disorders block ovulation, infection or endometriosis scar and obstruct the tubes, and uterine lesions impair implantation. Oocyte quantity and quality decline with age, especially after 35.

Classification

Primary infertility (no previous pregnancy)
Secondary infertility (after a previous pregnancy)
By factor: ovulatory, tubal, uterine, cervical, male, unexplained

Symptoms and signs

Inability to conceive
Irregular or absent periods (ovulatory factor)
Pelvic pain, painful periods or painful intercourse (endometriosis, pelvic infection)
Hirsutism and acne (polycystic ovary syndrome)
Galactorrhoea (hyperprolactinaemia)

Diagnosis

Clinical: History of both partners (cycles, previous pregnancies, infections, surgery, habits) and examination looking for signs of androgen excess, thyroid disease or galactorrhoea.
Tests: Confirmation of ovulation (mid-luteal progesterone); ovarian reserve with anti-Müllerian hormone or early-cycle FSH; TSH and prolactin; chlamydia testing; semen analysis of the partner.
Imaging: Transvaginal ultrasound (antral follicle count, fibroids, polyps); hysterosalpingography or sonohysterography for tubal patency and the uterine cavity; laparoscopy or hysteroscopy when indicated.

Differential diagnosis

Male-factor infertility
Early pregnancy loss mistaken for infertility
Infrequent or ill-timed intercourse
Undiagnosed thyroid or prolactin disorder

Goal of treatment

Find and treat the cause where possible and achieve a healthy single pregnancy with the least invasive effective option, while considering age, ovarian reserve and the couple's preferences.

Treatment

Lifestyle: Weight optimisation, stopping smoking, limiting alcohol, and treating underlying conditions such as thyroid disease.
Medical: Ovulation induction: letrozole (first line in polycystic ovary syndrome) or clomiphene, and gonadotropins in selected cases; dopamine agonists for hyperprolactinaemia.
Surgical: Laparoscopy for endometriosis or tubal disease and hysteroscopic removal of polyps, submucous fibroids, septum or adhesions.
Procedure: Assisted reproduction: intrauterine insemination, and in vitro fertilisation for tubal blockage, severe male factor, advanced age or failure of simpler treatments.
Follow-up: Ultrasound follow-up of follicle growth during stimulation to limit multiple pregnancy and ovarian hyperstimulation.

Complications

Psychological distress and relationship strain
Multiple pregnancy with fertility treatment
Ovarian hyperstimulation syndrome
Higher risk of ectopic pregnancy with tubal damage

Prognosis

Depends mainly on the woman's age and the cause. Many couples conceive with treatment of ovulatory disorders; success of assisted reproduction falls steadily after 35 and markedly after 40.

Prevention

Prevention, early diagnosis and treatment of sexually transmitted infections
Healthy weight and no smoking
Information about the age-related decline in fertility
Fertility preservation before gonadotoxic cancer treatment

Test yourself

Think of the answer, then tap the question to see it.

When is a couple considered infertile?

After 12 months of regular unprotected intercourse without pregnancy, or after 6 months if the woman is 35 or older.

What is the most common cause of anovulatory infertility?

Polycystic ovary syndrome.

Which infection is the classic cause of tubal-factor infertility?

Chlamydia (also gonorrhoea), through pelvic inflammatory disease that scars the tubes.

Which test evaluates tubal patency?

Hysterosalpingography (or sonohysterography with contrast; laparoscopy with dye test).

Which test of the partner is part of the initial work-up?

Semen analysis.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Infertility (World Health Organization, 2024); Female Infertility (MedlinePlus (U.S. National Library of Medicine), 2024).

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Representative model, for educational purposes only.

Uterine tubes highlighted on the Durgical 3D model