While the majority of heterosexual couples under 35 conceive without difficulty, many people need help to conceive. Infertility is still relatively common, and affects about 9% of males and 11% of females.

A diagnosis of infertility can be discouraging and taking action can feel intimidating. Knowing the main infertility diagnoses and how they might affect you can help you feel empowered and inform what next steps you may want to take.

6 Second Overview

• If you have ovaries, baseline fertility tests and a transvaginal ultrasound will be the first tests your doctor orders to determine the cause of your fertility issues.

• Common risk factors for infertility include age, tobacco or alcohol use, and being over- or underweight.

• Common infertility diagnoses include diminished ovarian reserve, ovulatory disorder, polycystic ovary syndrome (PCOS), tubal factor infertility, endometriosis, and uterine factor infertility.

• In most cases, infertility can be treated through assisted reproductive technology.

When Should I See a Doctor and What Tests Should I Expect?

People under 35 are commonly diagnosed with infertility if they are in a heterosexual relationship and have been actively trying to get pregnant for a year without success. For people over 35, infertility is diagnosed if they have been trying to conceive for six months. If either of these are the case for you, then you and your partner should see a doctor for fertility testing. If you are not heterosexual or are pursuing single parenthood, fertility testing will also be the first step toward determining what assisted reproductive technology will be best for you.

If you have ovaries and any of these are true for you, you should see a doctor before trying to conceive:

• Over 40 years of age.
• Irregular or absent periods.
• Very painful periods.
• History of pelvic inflammatory disease, endometriosis, or PCOS.
• Know that you have fertility issues.
• Three or more miscarriages
• Had treatment for cancer.

Your doctor may start out with a transvaginal ultrasound and some baseline fertility tests, including tests for AMH, FSH, Estradiol, Progesterone, LH, and hCG. These will give your doctor a sense of your ovarian reserve and identify any issues that may be preventing pregnancy.

If you have testes and any of these are true for you, you should see a doctor before trying to conceive:

• Low sperm count or no sperm.
• History of testicular, prostate, or sexual problems.
• Had treatment for cancer.
• Have a family history of infertility.

Male infertility is diagnosed when semen analysis of two samples taken 1-4 weeks apart identify issues with your semen. While the rest of this article will concentrate on infertility diagnoses for people with ovaries, our post on male factor infertility explores in depth the causes, diagnoses, and treatment options for people with testes who are experiencing infertility.

Common Risk Factors for Female Infertility

The risk factors for infertility for people with ovaries include:

• Age - Fertility gradually declines after age 30, and increasingly so after age 35, due to a decline in egg quality and quantity.
• Tobacco Use - Smoking can affect egg quality, as well as the ability to get and stay pregnant.
• Alcohol Use - An 18 year study of 7,393 women in Sweden found that “high alcohol consumption was associated with an increased risk of infertility examinations.” (1)
• Overweight - Multiple studies have shown that female infertility increases with obesity. (2)
• Underweight - Being underweight can affect ovulation.

Maintaining a healthy weight and healthy habits can help with fertility. However, there are infertility diagnoses that need more medical attention and possibly more intervention when trying to conceive.

What Are the Most Common Female Fertility Diagnoses?

Below are some common fertility diagnoses for people with ovaries:

• Diminished Ovarian Reserve - This occurs when the ovaries produce fewer eggs than most people a person’s age. Fortunately, this diagnosis does not appear to affect egg quality beyond what is normal for a person’s age. (3)

• Ovulatory Disorder - This diagnosis encompasses a group of conditions in which endocrine system dysregulation results in menstrual cycle irregularities or absent periods. (4) Treatment usually consists of lifestyle changes and/or hormone treatment.

• Polycystic Ovary Syndrome (PCOS) - This type of ovulatory disorder occurs when a reproductive hormone imbalance causes many follicles in the ovaries to develop. However, the follicles never develop into mature eggs, resulting in many small cysts. Fortunately, infertility caused by PCOS can be treated with lifestyle changes, medications, and/or in vitro fertilization (IVF).

• Tubal Factor - Damaged or blocked fallopian tubes can prevent the egg or fertilized egg from traveling to the uterus. Tubal factor infertility can result as a complication of pelvic inflammatory disease or endometriosis, both which can result in tubal blockages. While pregnancy is still possible if one fallopian tube is not blocked, IVF will be necessary if both tubes are blocked.

• Endometriosis - This occurs when when tissue that is similar to the inner lining of the uterus grows outside of the uterus. Endometriosis may result in scarring and inflammation and is associated with infertility. Infertility treatment options depend on the severity of endometriosis and may involve surgery (such as laparoscopy), hormone treatment, or both.

• Uterine Factor - Conditions affecting the uterus include uterine fibroids, polyps, adenomyosis (in which the endometrial lining of the uterus begins to grow into the wall of the uterus), a too-thin endometrial lining, uterine malformation (in which there are abnormalities in the uterus’ shape), or the absence of a uterus. Medications or surgery may be necessary to get pregnant.

While you may receive a diagnosis, unexplained fertility also occurs, in which doctors can’t pinpoint an exact diagnosis. However, medications or assisted reproductive treatments such as intrauterine insemination (IUI) or IVF can work even without an exact diagnosis.

Managing the Stress of an Infertility Diagnosis

Perhaps the greatest takeaway from this is that if you are experiencing infertility, you are not alone. For almost all the causes of infertility, there are assisted reproductive technologies that can address your infertility and enable you to get pregnant if you are able to carry a child.

A big hurdle to treatment is managing the stress of an infertility diagnosis, both to help you start the process of getting care and because – according to a Danish study of eight hundred eighteen couples about to start infertility treatment – stress can affect your fertility. (5) Maintaining a strong support system in your personal life can help you with the emotions that can come with an infertility diagnosis and provide a buoy as you begin infertility treatment. Seeking counseling can also help you manage the complex feelings that may arise.