If you’ve been trying without success to conceive for six months or more, you may be questioning whether you or your partner are infertile. Infertility is common, affecting 1 in 8 couples by one estimate (1).
Rest assured, conception isn’t a slam-dunk for anyone. One analysis suggested that couples aged 29-33 with no reproductive health issues stood only a 20-25% chance of conceiving in any given month (1).
The main sign or symptom of infertility is not getting pregnant (15). Many women and men actually don’t show signs infertility (beyond the obvious — not getting pregnant!). If you’re searching for clues to understand female infertility, we explain what may be behind some of the main causes behind infertility and if there are symptoms.
The typical menstrual cycle lasts 24-38 days, whereas irregular periods are cycles shorter than 24 days or longer than 38 days OR where the length of the cycle varies by more than 7–9 days, per the American College of Obstetricians and Gynecologists (ACOG) (2). While an irregular period is a good starting point for investigating infertility, it is not necessarily the cause of infertility (16).
An irregular period may signal an underlying hormonal imbalance. For example, too little progesterone may cause your uterine lining to shed prematurely, resulting in an abnormally short luteal phase (the average is 14 days (3)) and less success conceiving. Women with a luteal phase of 11 days or less either had more trouble getting pregnant or took longer to get pregnant, per a study on short luteal phases (4, 17)
Other causes of an irregular cycle may include (2):
You must ovulate to become pregnant (13), and the most obvious sign of not ovulating is not having a period, or irregular periods. However, absence of ovulation is more common than you might think. Up to 1/3 of women with regular menstrual cycles are anovulatory, per ACOG (7).
Hormonal disorders affect your menstrual cycle and ovulation and can lead to ovulation disorders. Polycystic ovarian syndrome (PCOS), a hormonal disorder affecting 1 in 10 women of reproductive age, is one of the most common causes of female infertility, per ACOG (5). PCOS may lead to brief or prolonged bleeding, an excess of male hormone in your body, or anovulation, a condition where your ovary doesn’t release an egg.
Other causes of anovulation include (6):
Ovulation pro tip: Regularly tracking your basal body temperature (BBT) is a free method to help determine if you’ve ovulated (14). Ovulation usually triggers a rise in BBT, but some small percentage may ovulate without seeing this biphasic pattern (13). You’ll want to look for your temp to rise by 3/10ths of a degree Fahrenheit and stay elevated until menstruation, usually about 12-15 days. Here’s a great explanation on BBT.
Sexually transmitted diseases (STDs) are no cause for shame. The U.S. Centers for Disease Control and Prevention (CDC) reported a record-breaking 2.3 million cases of chlamydia, gonorrhea, and syphilis in 2017 (8). The spread of these infections means your odds of having contracted one are higher.
Untreated chlamydia, gonorrhea, and syphilis may potentially harm your fertility, prompting health problems like pelvic inflammatory disease (PID), a bacterial infection affecting the fallopian tubes or ovaries. One in ten women with PID becomes infertile (9).
STDs also may lead to tubal factor infertility (TFI), a condition where damage to the fallopian tubes blocks the egg from reaching the uterus. TFI accounts for 30% of cases of female infertility in the United States (10).
If you’ve had chlamydia, gonorrhea, syphilis, or another STD, consult with your doctor. They may recommend imaging tests to view your uterus and fallopian tubes for signs of damage.
While age is not a direct sign of infertility, age does affect the fertility of men and women. This decline in fertility happens much sooner than most women expect (18). You may or may not have signs of your cycle changing if you have age-related infertility. At some point however, your cycles may become shorter or more irregular as you approach your late 30s and 40s (19).
Even though conception rates decline with age, a healthy pregnancy in your late 30s remains entirely possible.
When a research team tracked conception rates in a group of men and women of reproductive age, they found 58% of women over age 35 became pregnant within 6 months. Among the males over age 45, 52.9% achieved pregnancy with a partner within 6 months (11).
The study offers reassurance if you’re over 35 and trying to get pregnant. Still, if you believe your age, health condition, or another factor is interfering with conception, you may want to ask your provider about a fertility work-up.
The good news — new research shows the wealth of data you’ve gathered about your body through Fertility Awareness-based Methods can offer valuable insight about your menstrual health and its connection to your overall health (12). Go ahead and share your knowledge with your physician.