Infertility is defined as the inability to get pregnant for at least one year without success when a woman is under 35. If the woman is over 35, then infertility is diagnosed when she is unable to get pregnant after 6 months of trying. Approximately 1 in 7 couples have difficulty conceiving after 1 year of unprotected sex. If there are problems with the woman’s ovulation or reproductive tract, then it is considered female infertility.


To get pregnant, four criteria must be met:

  1. Successful ovulation
  2. Viable sperm
  3. Regular sexual intercourse
  4. A normal uterus and fallopian tubes

When one or more of these requirements are not met, infertility may be an issue. Sometimes the cause of infertility is unknown, but several factors contribute to female infertility.

Ovulation Disorders

These disorders cause a woman’s ovulation to become irregular or stop altogether.

  • Polycystic Ovarian Syndrome
  • Low ovarian reserve due to:
    • Ovarian insufficiency
    • Age and/or Perimenopause
  • Low hormone production caused by:
    • Hypothalamic dysfunction
    • Exercise
    • Diet
  • Other hormone disorders
    • Thyroid
    • Adrenal
    • Prolactin


In endometriosis, the tissue that is supposed to grow inside the uterus implants and grows outside of the uterus. The fallopian tubes, ovaries, and the outside surface of the uterus may be affected. Sometimes the uterine lining is also affected, which interferes with egg implantation.

Blockage or Abnormalities of the Reproductive Tract

If there is a blockage in the fallopian tubes, cervix, or elsewhere in the reproductive tract, successful ovulation can be impeded.

  • Pelvic inflammatory disease
  • Previous abdominal or pelvic surgery
  • Endometriosis scarring
  • Benign tumors or fibroids blocking fallopian tubes
  • Cervical stenosis – narrowing of the cervix
  • Uterine abnormalities such as abnormal shape or birth defects of the uterus


If you have not conceived after one year of actively trying, then you should consult a fertility specialist. The doctor will perform tests to diagnose female infertility.

  • Ovulation Testing: Tests can be performed to detect the levels of the hormones associated with ovulation. Over-the-counter home testing kits are available to test for luteinizing hormone (LH), which increases before ovulation. A doctor can perform blood tests to check progesterone, which increases after ovulation.
  • Ovarian Reserve Testing: Testing that helps doctors determine the quantity and quality of the eggs a woman has available for ovulation. Blood and imaging (ultrasound) testing are typically performed when women are at a higher risk of having a low egg reserve, which might occur in women over 35 years old, for example.
  • Other Hormone Testing: Blood tests can check the levels of other hormones related to ovulation as well as pituitary and thyroid hormones which contribute to the reproductive process.
  • Imaging Tests: Pelvic ultrasounds can detect uterine abnormalities or fallopian tube disorders. A special ultrasound using saline can be used to get a more detailed view of the uterus. There is also an x-ray that uses contrast that can be used to check for tubal problems.
  • More Detailed Testing: These are rare and depend on the results of prior tests. These more in-depth tests may include hysteroscopy (scope to view the uterus & fallopian tubes), laparoscopy, or genetic testing.


If female infertility is diagnosed, there are several treatment options. A fertility specialist can work with you to find the best plan for you and your partner. This may include some form of Assisted Reproductive Technology (ART).

  • Female infertility treatments for women who want to use their eggs will probably include ovarian stimulation, also called ovulation induction. Hormonal medications are used to stimulate the ovaries to produce multiple eggs during a single cycle. Once the eggs are developed in the ovarian follicles, another medication is given to trigger ovulation.
  • In a treatment like in vitro fertilization (IVF), the eggs are then retrieved during an outpatient procedure to be combined with the partner or donor’s sperm in a lab setting.
  • If intrauterine insemination (IUI) is being performed, the eggs are not retrieved, and a procedure is done to insert sperm directly into the uterus so fertilization can take place directly in the womb.
  • If there are issues that prevent one or both partners from using their reproductive materials then a fertility specialist may recommend ART with Third-Party Assistance. This may include the use of a donor egg, donor sperm, or a gestational carrier if the female partner is unable to carry the baby.

Make an Appointment

At Carolinas Fertility Institute, we have decades of experience providing patients in North Carolina with personalized fertility care. If you have questions or concerns about fertility, including female infertility, call (336) 448-9100 to make an appointment at one of our offices in the Triad, or call (844) 686-2233 to make an appointment at our Charlotte office. You can also request an appointment online at your convenience.