What are the signs of female infertility, and when should I get tested?
Some women experience noticeable signs that may point to fertility concerns, such as irregular or absent menstrual cycles, very painful periods, or a history of miscarriage. However, many causes of female infertility do not cause obvious symptoms at all, which means fertility challenges can sometimes go undetected without testing.
Infertility is typically defined as the inability to conceive after 12 months of trying, or six months for women over age 35. That said, fertility testing isn’t only for those who are actively trying to get pregnant. Women who are planning ahead, have known risk factors, or simply have questions about their reproductive health may also benefit from early evaluation. Fertility testing can provide valuable insight, peace of mind, and guidance, no matter where you are in your family-building journey.
Possible Causes of Female Infertility
Fertility testing can help identify a wide range of medical, hormonal, and anatomical factors that may affect a woman’s ability to conceive. Common causes of female infertility include:
- 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
In some cases, more than one factor may be involved, and fertility testing helps clarify how these conditions affect reproductive health and treatment planning.
What is AMH testing, and why does it matter?
AMH testing measures the level of Anti-Müllerian Hormone (AMH) in the blood, a hormone produced by small follicles in the ovaries. Because AMH reflects the number of eggs remaining, it is considered one of the most reliable indicators of ovarian reserve and is a cornerstone of female fertility testing.
AMH levels tend to decline naturally with age, which is why the test is often used to help assess fertility potential over time. Higher AMH levels generally suggest a higher egg quantity, while lower AMH levels may indicate diminished ovarian reserve. It’s important to note that AMH does not measure egg quality or predict whether pregnancy will occur naturally. Still, it can help fertility specialists understand how the ovaries may respond to treatment.
At Reproductive Biology Associates, AMH testing is interpreted alongside other fertility evaluations, such as ultrasound findings, hormone levels, and age-related factors. When viewed in context, AMH results help guide personalized fertility planning, whether that means trying to conceive, pursuing fertility treatment, or considering fertility preservation options.
What other female fertility testing is part of an overall evaluation?
In addition to AMH testing, a comprehensive fertility evaluation often includes a combination of diagnostic tools that assess hormonal health, ovulation, ovarian reserve, and reproductive anatomy. At Reproductive Biology Associates, these tests are selected based on your medical history and goals to provide a complete picture of your fertility.
Medical History and Physical Examination
A thorough review of your medical, reproductive, and menstrual history helps identify patterns or risk factors that may affect fertility. A physical exam may also be performed to evaluate overall reproductive health and guide appropriate testing.
Ovulation Assessment
Ovulation is evaluated through cycle tracking, hormone testing such as progesterone levels, and sometimes ultrasound monitoring. These tools help confirm whether ovulation is occurring regularly and predict the timing of ovulation.
Hormonal Testing
Blood tests may be used to measure key reproductive hormones, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, and thyroid hormones. Hormone levels provide insight into ovarian function, cycle regulation, and overall endocrine health.
Ovarian Reserve Testing
Ovarian reserve refers to the quantity of eggs remaining in the ovaries. In addition to AMH testing, ovarian reserve is often assessed through ultrasound-based antral follicle counts to help guide fertility planning and treatment decisions.
Hysterosalpingography (HSG)
An HSG is an X-ray procedure that uses contrast dye to evaluate the shape of the uterus and determine whether the fallopian tubes are open. It is commonly used to diagnose tubal blockages or uterine abnormalities.
Sonohysterography or FemVue®
FemVue® is an ultrasound-based procedure that assesses fallopian tube patency using saline and air contrast rather than X-ray dye. This minimally invasive test provides real-time imaging of the uterus and fallopian tubes and may be used as an alternative to traditional HSG in some cases.
Transvaginal Ultrasound Testing
Transvaginal ultrasound allows physicians to closely evaluate the uterus and ovaries, monitor follicle development, and identify structural concerns such as cysts or fibroids.
Saline Infusion Sonogram (SIS)
An SIS uses saline and ultrasound imaging to provide a detailed view of the uterine cavity. This test helps detect abnormalities such as polyps, fibroids, or scar tissue that may affect implantation.
Laparoscopy
Laparoscopy is a minimally invasive surgical procedure that may be recommended when other testing does not fully explain infertility. It can help diagnose conditions such as endometriosis, pelvic adhesions, or other hidden causes of infertility.
Genetic Testing
In certain situations, genetic testing may be recommended to identify inherited or chromosomal conditions that could affect fertility, pregnancy outcomes, or treatment planning.
