Symptoms

The main symptom of infertility is the inability to get pregnant. A menstrual cycle that is too long (35 days or more), too short (less than 21 days), irregular, or absent may mean that you are not ovulating. There may be no other signs or symptoms. 

When to see a doctor

When you should see a doctor may depend on your age:

• Up to age 35, most doctors recommend trying to get pregnant for at least a year before testing or treatment.
• If you are between 35 and 40, discuss your concerns with your doctor after trying for six months.
• If you are older than 40, your doctor may suggest testing or treatment right away.
• Your doctor might also start testing or treatment right away if you or your partner have known fertility problems or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, cancer treatments, or endometriosis.

Causes

For pregnancy to occur, every step of the human reproductive process must occur correctly. The steps in this process are:

• One of the two ovaries releases a mature egg.
• The egg is picked up by the fallopian tubes.
• The sperm swims up the cervix, through the uterus, and into the fallopian tube to reach the egg for fertilization.
• The fertilized egg travels down the fallopian tube into the uterus.
• The fertilized egg nests inside the uterus and grows.

In women, this process can be disrupted by a number of factors at any stage. Female infertility is caused by one or more of the following factors.

​Risk factors

Certain factors can increase your risk for infertility, including:

• Age. The quality and quantity of a woman’s eggs decrease with age. After your mid-30s, follicle loss accelerates, resulting in fewer, poorer-quality eggs. This makes conception more difficult and increases the risk of miscarriage.
• Smoking. Smoking not only damages your cervix and fallopian tubes but also increases your risk of miscarriage and ectopic pregnancy. Smoking is also thought to age your ovaries and deplete your eggs prematurely. Stop smoking before you start fertility treatment.
• Weight. Being overweight or severely underweight can interfere with ovulation. Achieving a healthy body mass index (BMI) can increase the frequency of ovulation and the likelihood of pregnancy.
• Sexual history. Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Unprotected sex with multiple partners increases your risk for a sexually transmitted infection, which can lead to fertility problems later.
• Alcohol. Excessive alcohol consumption can affect fertility.

Prevention

For women who want to get pregnant soon or in the future, these tips may be helpful:

• Maintain a healthy weight. Overweight and underweight women are at increased risk for ovulation problems. If you need to lose weight, exercise moderately. Strenuous, intense exercise of more than five hours per week has been linked to decreased ovulation.
• Give up smoking. Tobacco has numerous negative effects on fertility as well as your overall health and the health of the fetus. If you smoke and are considering pregnancy, quit now.
• Avoid alcohol. Heavy drinking can lead to decreased fertility. And any alcohol consumption can affect the health of the developing fetus. If you plan to get pregnant, avoid alcohol and do not drink alcohol during pregnancy.

Reduce stress. Some studies have shown that stress can lead to worse infertility outcomes in couples. Try to reduce the stress in your life before you try to get pregnant.