What are the signs of female infertility, and when should I get tested?
Fertility challenges are not always accompanied by obvious or consistent symptoms. While some women experience irregular or absent periods, unusually heavy or painful cycles, or a history of pregnancy loss, others have no noticeable signs at all, yet still encounter difficulties conceiving.
Because symptoms alone are not a reliable guide, recommendations for fertility evaluation are shaped primarily by age. Women under 35 are generally encouraged to seek a specialist after trying to conceive for twelve months without success. For women 35 and older, that window shortens to six months.
Testing does not have to wait for a problem to present itself, however. Women with a personal or family history of conditions that may affect fertility, those considering delaying pregnancy, or anyone considering egg freezing or future family-building may benefit from an earlier, proactive evaluation.
Possible Causes of Female Infertility
A comprehensive fertility evaluation can detect a wide range of underlying factors that may be contributing to difficulty conceiving, including:
- Polyendocrine metabolic syndrome (PMOS), formerly known as polycystic ovary syndrome (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
What is AMH testing and why does it matter?
AMH testing refers to the measurement of Anti-Müllerian Hormone, a hormone secreted by the small follicles that hold immature eggs in the ovaries. Measuring AMH offers a reliable window into ovarian reserve: the quantity of eggs a woman has available at any given point in time.
Higher AMH levels are generally associated with a more robust ovarian reserve, while lower levels may indicate a diminished reserve.
It’s worth noting that AMH reflects the quantity of eggs, and not their quality. In other words, while an AMH result can indicate how many eggs are present, it does not predict whether those eggs will result in a successful pregnancy. Additionally, results are also always considered relative to your age, since ovarian reserve naturally decreases over time.
What other female fertility testing is part of an overall evaluation?
A thorough fertility evaluation looks at multiple dimensions of reproductive health simultaneously. The specific tests recommended will depend on your history, symptoms, and goals; however, most evaluations draw from a combination of the following:
Medical History and Physical Examination
Every evaluation at Indiana Fertility Institute begins with a detailed conversation. Your provider will review the details of your menstrual cycle, any previous pregnancies, prior diagnoses or surgeries, current medications, and relevant family health history. Following this discussion, your provider will perform a physical exam to note any observable concerns that may guide testing decisions.
Ovulation Assessment
For conception to occur, your ovaries must release at least one mature egg every month. To confirm that ovulation is happening consistently, your provider may suggest methods for cycle tracking, progesterone testing, or ultrasound monitoring of follicle development.
Hormonal Testing
A variety of hormones influence fertility. Bloodwork may be used to evaluate follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, thyroid hormones, and other key hormones that provide insight into reproductive function.
Ovarian Reserve Testing
Ovarian reserve testing helps estimate the quantity of eggs remaining in the ovaries. In addition to AMH testing, providers may use ultrasound imaging to perform an antral follicle count.
Hysterosalpingography (HSG)
An HSG is an X-ray-based procedure that evaluates both the uterine cavity and the fallopian tubes. A contrast dye is introduced through the cervix and tracked via X-ray imaging as it moves through the uterus and into the tubes. The resulting images can reveal structural abnormalities within the uterus and confirm whether the fallopian tubes are open.
Transvaginal Ultrasound Testing
A transvaginal ultrasound uses a small probe placed inside the vagina to create detailed images of the reproductive organs. This imaging study allows fertility specialists to examine the uterus, ovaries, uterine lining, and ovarian follicles.
Laparoscopy
Some conditions that significantly impact fertility are not visible through bloodwork or standard imaging. Laparoscopy—a minimally invasive surgical procedure—allows a reproductive specialist to view the uterus, fallopian tubes, ovaries, and surrounding pelvic structures directly. It is often recommended when endometriosis, pelvic adhesions, or scar tissue is suspected as the cause of infertility.
Genetic Testing
Genetic evaluation may be recommended when a patient has a personal or family history of hereditary conditions, has experienced recurrent pregnancy loss, or presents with findings that suggest a chromosomal contributor to fertility challenges. Carrier screening, karyotyping, and other forms of genetic analysis can provide information that shapes treatment decisions and informs family-building planning. For patients pursuing IVF, preimplantation genetic testing (PGT) is also available to screen embryos before transfer.
Saline Infusion Sonogram (SIS)
A saline infusion sonogram (SIS) is a specialized ultrasound procedure used to evaluate the uterine cavity. During the exam, sterile saline is introduced into the uterus to improve visualization of the uterine lining and identify abnormalities such as polyps, fibroids, adhesions, or structural irregularities.
