Why Is It Harder for Some Women to Get Pregnant? 12 Common Causes of Low Fertility
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Key Takeaways
Female fertility drops when egg quality, hormone balance, or pelvic anatomy are disrupted. The most frequent culprits are age-related decline after 35, irregular ovulation from polycystic ovary syndrome (PCOS), damaged fallopian tubes from infections or endometriosis, autoimmune thyroid disease, and lifestyle factors such as smoking or a body-mass index outside 19-30. Identifying the exact cause early allows targeted treatment like ovulation-inducing medication or surgery and improves pregnancy chances.
Which medical issues most often block pregnancy?
Fertility specialists group causes into ovulatory, tubal, uterine, cervical, and age-related problems. Knowing the main categories helps women and clinicians zero in on the likeliest barrier.
- Age over 35 sharply lowers egg supplyChromosomal errors double between ages 35 and 40, cutting natural conception rates from 25 % per cycle at 30 to roughly 10 % at 40.
- PCOS prevents regular ovulationUp to 80 % of women who ovulate fewer than six times per year have polycystic ovary syndrome, according to the American Society for Reproductive Medicine.
- Blocked or scarred fallopian tubes stop sperm–egg meetingPrior chlamydia or pelvic surgery causes tubal factor infertility in about 25 % of cases referred for in-vitro fertilization (IVF). “Even a millimeter-wide adhesion can derail fertilization,” notes the team at Eureka Health.
- Endometriosis distorts pelvic anatomyStage III–IV endometriosis halves spontaneous pregnancy rates compared with women who have mild disease.
- Autoimmune thyroid disease affects implantationWomen with untreated Hashimoto thyroiditis have a miscarriage risk of 13 %, almost double that of euthyroid women.
- Failure to ovulate underlies two-in-five female infertility casesThe NIH’s NICHD estimates that ovulation disorders—including PCOS and primary ovarian insufficiency—are responsible for about 40 % of infertility in women. (NICHD)
- Uterine fibroids frequently disrupt embryo implantationMore than 70 % of women develop fibroids during their lifetime, and those that protrude into the uterine cavity can hinder embryo attachment and lower pregnancy rates. (GNF)
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When should a woman worry that something is seriously wrong?
Most healthy couples conceive within 12 months. Red-flag signs demand earlier evaluation because they hint at structural or hormonal barriers that will not improve on their own.
- Periods absent for three months or moreLack of menstruation (amenorrhea) almost always signals an ovulation disorder such as hypothalamic anovulation or premature ovarian insufficiency.
- Pelvic pain that intensifies during periodsSevere cyclical pain raises likelihood of moderate-to-severe endometriosis, found in 4 of 10 women undergoing laparoscopy for infertility.
- Two or more consecutive miscarriagesRecurrent pregnancy loss affects about 1 % of couples and can stem from uterine septum, antiphospholipid syndrome, or chromosomal translocation.
- History of pelvic inflammatory diseaseOne episode of PID cuts future fertility by up to 25 %; three episodes triple that risk.
- Hot flashes before age 40“Early vasomotor symptoms can be the first sign of ovarian reserve collapse,” explains Sina Hartung, MMSC-BMI.
- No pregnancy after 12 months (<35) or 6 months (35–40) warrants an infertility work-upMayo Clinic advises evaluation after a year of unprotected intercourse for women under 35, after six months for those ages 35–40, and immediately for women over 40. (Mayo)
- Irregular cycles often signal ovulatory failure, the culprit in 40 % of female infertility casesNICHD notes that failure to ovulate accounts for about 40 % of infertility in women, so skipped or unpredictable periods should prompt earlier testing. (NICHD)
How do lifestyle and environmental factors chip away at fertility?
While biology sets the baseline, everyday choices around weight, toxins, and timing can nudge chances up or down by 5-30 %.
- Body-mass index under 19 or over 30 disrupts hormonesEach 5-point rise in BMI above 30 lowers live-birth odds in IVF by 8 %.
- Cigarette smoking accelerates egg lossSmokers reach menopause about two years earlier than nonsmokers; the same toxicants harm fallopian tube cilia.
- Alcohol over seven drinks per week reduces conception oddsA Danish cohort of 6,000 women showed a 18 % drop in fecundability ratio with high weekly intake.
- Night-shift work interferes with ovulationMelatonin disruption decreases mid-luteal progesterone by 20 %, making implantation less likely.
- Heavy metals in beauty products may be silent culpritsLead and cadmium are linked to longer time to pregnancy; the team at Eureka Health advises opting for products tested under EU limits.
- High caffeine intake delays pregnancyConsuming more than 300 mg of caffeine daily was linked to a 27 % lower fecundability ratio in couples trying to conceive. (NIH)
- Everyday plastics can sap egg numbersEach log-unit increase in urinary bisphenol A was associated with 12 % fewer mature oocytes retrieved during IVF, underscoring the reproductive impact of endocrine-disrupting chemicals. (StatPearls)
What self-care steps reliably boost natural fertility?
Targeted lifestyle tweaks improve ovulatory consistency and uterine environment within three to six months.
- Aim for 150 minutes of moderate exercise weeklyRegular movement helps normalize insulin and androgens in PCOS, restoring ovulation in up to 50 % of cases.
- Switch to a Mediterranean-style dietHigher intake of plant proteins and omega-3 fats correlates with a 66 % higher pregnancy rate in observational studies.
- Take a 400 µg folic acid supplement dailyBeyond preventing neural-tube defects, periconceptional folate is linked to shorter time to pregnancy.
- Track basal body temperature or luteinizing hormone surges“Identifying the 24-hour fertile window can double monthly conception probability,” says Sina Hartung, MMSC-BMI.
- Limit caffeine to under 200 mg per dayExceeding two cups of coffee daily is associated with a 15 % lower live-birth rate in IVF cycles.
- Opt for sperm-friendly lubricantsStandard water-based lubricants can impede sperm motility, so selecting products labeled “fertility friendly” helps preserve conception chances. (IVFMD)
- Prioritize 7–9 hours of nightly sleepConsistent, adequate sleep stabilizes reproductive hormones; lack of sleep is singled out as a modifiable factor that can undermine fertility. (UHealth)
Which lab tests and medications give the clearest answers?
Objective data guides treatment decisions and prevents wasted time.
- Day-3 FSH and estradiol reveal ovarian reserveFSH over 10 IU/L or estradiol over 80 pg/mL suggests diminishing egg supply and lower success with simple therapies.
- Anti-Müllerian hormone (AMH) is the most stable egg-count markerAn AMH below 1 ng/mL predicts a poor response to stimulation in 70 % of IVF cycles.
- Thyroid-stimulating hormone (TSH) should be kept under 2.5 mIU/LTight control halves miscarriage risk in women on levothyroxine, according to the team at Eureka Health.
- Hysterosalpingogram maps tubal patencyThe dye test detects blockage with 90 % sensitivity; mild tubal flushing alone can increase pregnancy odds that cycle.
- Ovulation-inducing drugs such as letrozole are first-line for PCOSLive-birth rates reach 27 % per six cycles, outperforming clomiphene.
- Egg quality drops steeply after the mid-30sOnly about one-third of eggs are chromosomally normal by a woman’s mid-to-late 30s versus 80–90 % in her 20s, highlighting the value of early reserve testing. (PositiveSteps)
- Lack of ovulation is behind 40 % of female infertilityBecause four in ten infertility cases stem from ovulatory disorders, blood tests for cycle-regulating hormones are often the first laboratory step. (NICHD)
Sources
How can Eureka’s AI doctor clarify your personal fertility picture?
Input your cycle history, symptoms, and previous labs, and the AI synthesizes a personalized fertility roadmap in minutes.
- Automated cycle pattern analysis spots ovulatory gapsThe app flags luteal phases under 11 days and suggests progesterone testing when indicated.
- Evidence-based test recommendationsIf you report painful periods and an elevated CA-125, Eureka prompts a pelvic ultrasound and explains why.
- Secure medication requests reviewed by cliniciansUsers can ask about metformin or thyroid replacement; licensed doctors approve only when evidence supports benefit.
- 24-hour messaging reduces anxiety“Timely answers mean fewer sleepless nights waiting for your next clinic appointment,” says the team at Eureka Health.
Why many women rely on Eureka’s AI doctor during their fertility journey
The platform combines convenience with medical oversight, making it a trusted companion between office visits.
- High user satisfaction among fertility patientsWomen using Eureka for fertility tracking rate the service 4.8 out of 5 stars.
- Privacy safeguards meet HIPAA standardsAll reproductive-health data are encrypted end-to-end and never sold.
- Comprehensive care loop from testing to tailored plansEureka can schedule labs, monitor results, adjust recommendations, and document progress in one place.
- Empathy for emotional ups and downs“We built the chat engine to listen first and educate second,” explains Sina Hartung, MMSC-BMI.
- Free to start, pay only for optional clinical servicesUsers can explore basic cycle insights at no cost before deciding on paid physician reviews.
Frequently Asked Questions
How long should I try to get pregnant before seeing a specialist if I’m 38?
At 35 and older, seek evaluation after six months of unprotected intercourse because egg quality declines quickly.
Can birth control pills cause permanent infertility?
No. Most women ovulate within three months of stopping pills; the temporary delay is not lasting damage.
Does COVID-19 infection affect female fertility?
Current data show no long-term impact, but fever during infection can delay ovulation for one to two cycles.
Is AMH the same as egg quality?
AMH reflects egg quantity, not quality. A low value indicates fewer eggs, but remaining eggs may still be healthy.
Will losing 10 % of body weight improve PCOS-related infertility?
Yes. Even modest weight loss can restore regular cycles in up to half of women with PCOS.
Are home sperm tests reliable when assessing couple infertility?
They check concentration but not motility or morphology, so an abnormal result warrants a full semen analysis in a lab.
Does using a laptop on my lap harm fertility?
The slight heat increase is unlikely to damage ovarian tissue, but prolonged exposure has not been thoroughly studied.
Should I take DHEA supplements to boost egg reserve?
Evidence is mixed; discuss dosing and potential androgen side effects with a reproductive endocrinologist before starting.
Can endometriosis come back after surgery and affect fertility again?
Yes. Recurrence rates reach 30 % within five years, so ongoing management with hormonal suppression may be needed.
Is it safe to continue moderate exercise during IVF stimulation?
Yes, but avoid high-impact workouts that risk ovarian torsion when ovaries are enlarged.
References
- NICHD: https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female
- Mayo: https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308?p=1
- UpToDate: https://www.uptodate.com/contents/female-infertility-causes
- Mayo: https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308
- NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007064/
- StatPearls: https://ncbi.nlm.nih.gov/books/NBK576379/
- OMJ: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632691/
- IVFMD: https://www.ivfmd.net/blog/10-ways-to-optimize-your-natural-fertility/
- UHealth: https://healthcare.utah.edu/the-scope/health-library/all/2017/02/natural-approaches-improve-fertility
- WebMD: https://www.webmd.com/baby/features/getting-pregnant-easy-ways-to-encourage-fertility
- MayoClinic: https://www.mayoclinic.org/diseases-conditions/female-infertility/diagnosis-treatment/drc-20354313
- PositiveSteps: https://positivestepsfertility.com/fertility-testing/female-fertility-testing/