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# 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

Tap one to see what it is and open it in 3D.

- [Uterine tubes](https://durgical.com/en/anatomy/uterine-tube/)
- [Ovaries](https://durgical.com/en/anatomy/ovary/)
- [Endometrium](https://durgical.com/en/anatomy/endometrium/)
- [Ampulla of uterine tube](https://durgical.com/en/anatomy/ampulla-of-uterine-tube/)
- [Infundibulum and fimbriae](https://durgical.com/en/anatomy/infundibulum-of-uterine-tube/)
- [Body of uterus](https://durgical.com/en/anatomy/body-of-uterus/)
- [Cervix](https://durgical.com/en/anatomy/cervix-of-uterus/)
- [Myometrium](https://durgical.com/en/anatomy/myometrium/)

## Why it happens

- [The menstrual cycle: ovary and endometrium](https://durgical.com/en/physiology/the-menstrual-cycle-ovary-and-endometrium/)
- [Fertilization and implantation](https://durgical.com/en/physiology/fertilization-and-implantation/)
- [Uterine tube](https://durgical.com/en/histology/uterine-tube/)

## 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](https://durgical.com/en/anatomy/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)

## Red flags

- Age 35 or older (start evaluation after 6 months)
- Amenorrhoea or very irregular cycles
- Known tubal disease, endometriosis or previous pelvic infection
- Known male-factor problem in the partner

## 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](https://durgical.com/en/anatomy/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.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/female-infertility/)

## Related conditions

- [Polycystic ovary syndrome](https://durgical.com/en/conditions/polycystic-ovary-syndrome/)
- [Endometriosis](https://durgical.com/en/conditions/endometriosis/)
- [Pelvic inflammatory disease](https://durgical.com/en/conditions/pelvic-inflammatory-disease/)
- [Chlamydia infection](https://durgical.com/en/conditions/chlamydia-infection/)
- [Gonorrhoea](https://durgical.com/en/conditions/gonorrhoea/)
- [Uterine fibroids (leiomyomas)](https://durgical.com/en/conditions/uterine-fibroids/)
- [Asherman syndrome (intrauterine adhesions)](https://durgical.com/en/conditions/asherman-syndrome/)
- [Primary ovarian insufficiency](https://durgical.com/en/conditions/primary-ovarian-insufficiency/)
- [Functional hypothalamic amenorrhoea](https://durgical.com/en/conditions/functional-hypothalamic-amenorrhoea/)
- [Prolactinoma (hyperprolactinaemia)](https://durgical.com/en/conditions/prolactinoma/)
- [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/)
- [Ectopic pregnancy](https://durgical.com/en/conditions/ectopic-pregnancy/)
- [Ovarian hyperstimulation syndrome](https://durgical.com/en/conditions/ovarian-hyperstimulation-syndrome/)
- [Varicocele](https://durgical.com/en/conditions/varicocele/)

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

Sources: [Infertility](https://www.who.int/news-room/fact-sheets/detail/infertility) (World Health Organization, 2024); [Female Infertility](https://medlineplus.gov/femaleinfertility.html) (MedlinePlus (U.S. National Library of Medicine), 2024).

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Source: https://durgical.com/en/conditions/female-infertility/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/female-infertility/