Signs of Female Infertility: Symptoms, Causes and When to Seek Help
Medically reviewed by Mr Amer Raza MBBS MRCOG, Consultant Gynaecologist, Ovara Health (GMC 5205372) | Last reviewed: 2 July 2026
Key Facts: The main signs of female infertility are not conceiving after 12 months of regular unprotected sex, irregular or absent periods, very painful or heavy periods and known conditions such as PCOS or endometriosis. Many women have no symptoms at all, which is why fertility testing matters. Most causes are treatable once identified.
Around one in seven couples in the UK have difficulty conceiving, and in about half of those couples a female factor is involved. The difficult truth about female infertility is that it often has no obvious symptoms, which means many women only discover a problem when they start trying for a baby.
This guide explains the signs that can point to a fertility problem, the most common causes, how female infertility is investigated and when to seek specialist help.
Quick Answer: The clearest sign of female infertility is not becoming pregnant after 12 months of regular unprotected sex (or 6 months if you are 35 or over). Warning signs include irregular, absent, very painful or very heavy periods, and hormonal symptoms such as acne, excess facial hair or sudden weight change. Many women have no signs at all, so testing is the only way to know for certain.
What are the signs of female infertility?
The most reliable sign is simply time: not conceiving after 12 months of regular unprotected intercourse suggests a fertility problem worth investigating. Beyond that, the signs that most often point to an underlying cause are:
- Irregular or absent periods. Cycles shorter than 21 days, longer than 35 days, or periods that stop altogether usually indicate that ovulation is irregular or not happening
- Very painful periods. Pain that interferes with daily life can be a sign of endometriosis, which is strongly linked to fertility problems
- Very heavy periods. Heavy bleeding can be associated with fibroids or polyps inside the womb, which can interfere with implantation
- Pain during sex. Deep pain during intercourse can point to endometriosis or pelvic scarring
- Hormonal signs. Persistent acne, excess facial or body hair, thinning scalp hair or unexplained weight gain can indicate polycystic ovary syndrome (PCOS)
- Milky nipple discharge when not breastfeeding, which can indicate a raised prolactin level that suppresses ovulation
It is just as important to say what is NOT on this list: many women with reduced fertility have completely normal periods and no symptoms whatsoever. An absence of signs is not reassurance, which is why fertility screening exists.
What are the most common causes of female infertility?
Female infertility usually comes down to a problem in one of four areas: ovulation, the fallopian tubes, the womb itself or egg quality and quantity. The most common causes are:
Ovulation problems
The single biggest cause. If an egg is not released regularly, conception cannot happen regularly. Polycystic ovary syndrome (PCOS) is the most common reason, and thyroid problems, significantly low or high body weight, excessive exercise and raised prolactin can all disrupt ovulation too.
Blocked or damaged fallopian tubes
The tubes carry the egg to the womb and are where fertilisation happens. Previous pelvic infection, chlamydia, endometriosis or earlier abdominal surgery can block or scar them, which stops egg and sperm meeting.
Endometriosis
Tissue similar to the womb lining growing outside the womb can distort the pelvic anatomy, damage the ovaries and cause inflammation that affects egg quality. If you have very painful periods alongside difficulty conceiving, endometriosis should be actively considered. Our guide to why endometriosis takes so long to diagnose explains the assessment route.
Fibroids and womb problems
Fibroids, particularly those that bulge into the cavity of the womb, and endometrial polyps can interfere with implantation. Our fibroids guide covers how they are found and treated.
Age and egg reserve
Fertility declines with age, more steeply from the mid-30s, because both the number and quality of eggs fall. This is the one cause that cannot be treated, which is why age is the main factor in deciding how quickly to investigate and act.
In around a quarter of couples no cause is found despite full investigation, which is called unexplained infertility. That is frustrating to hear, but many couples with unexplained infertility do conceive, and it does not close off treatment options.
Can you be fertile and then become infertile?
Yes. This is called secondary infertility, and it means difficulty conceiving after previously having a baby without problems. It is at least as common as primary infertility and is investigated the same way. New factors such as age, a pelvic infection since the last pregnancy, surgery, endometriosis progression, weight change or a new partner’s fertility can all play a part. Having conceived before does not guarantee ongoing fertility, and secondary infertility deserves the same prompt assessment.
Do medications or lifestyle affect female fertility?
Some do. Chemotherapy and pelvic radiotherapy can permanently affect the ovaries, and some antipsychotic medicines raise prolactin, which suppresses ovulation. Long-term high-dose use of anti-inflammatory painkillers can temporarily interfere with ovulation, and recreational drugs affect fertility too. Never stop a prescribed medicine on your own; raise it with your Consultant instead.
Lifestyle genuinely matters as well. Smoking accelerates egg loss and is strongly linked to earlier menopause, alcohol reduces fertility at higher intakes, and being significantly under or over a healthy weight disrupts ovulation. These are also the factors most within your control, and improving them measurably improves conception rates.
When should you seek help for fertility problems?
The guidance is clear and worth acting on:
- Under 35: seek assessment after 12 months of regular unprotected sex without conceiving
- 35 or over: seek assessment after 6 months
- Straight away if you have irregular or absent periods, known PCOS, endometriosis or pelvic infection history, previous cancer treatment, or you are planning pregnancy later and want to understand your fertility now
Waiting rarely improves the situation, and early answers widen your options. Fertility investigation is not a commitment to treatment; it is information.
Worried about your fertility? You do not need a GP referral to be seen at Ovara Health. Call us on 0207 751 4488 or book online for a private fertility assessment with a Consultant Gynaecologist in Chelsea. Severe sudden pelvic pain needs same-day emergency care: call 999 or go to A&E.
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How is female infertility investigated?
Investigation is logical and usually quick. At Ovara Health it typically includes:
- A consultation covering your cycle history, medical and surgical history, lifestyle and how long you have been trying
- Blood tests checking ovulation hormones, thyroid function, prolactin and AMH (anti-Mullerian hormone), which indicates your egg reserve
- A transvaginal ultrasound scan to examine the ovaries, count follicles and check the womb for fibroids or polyps
- Follicle tracking where scans across one cycle confirm whether and when you ovulate. Our guide to follicle tracking explains how it works
- Tubal patency testing where indicated, to check whether the fallopian tubes are open
- Partner testing. A semen analysis matters in every case, because male factors contribute in around half of couples
Our post on fertility screening tests covers what each test tells you and when it is worth doing before trying for a baby.
How is female infertility treated?
Treatment depends on the cause, and many causes have straightforward options:
- Ovulation problems: weight and lifestyle changes plus ovulation induction medication restore regular ovulation for most women with PCOS
- Thyroid or prolactin problems: treating the underlying hormone issue often restores fertility on its own
- Fibroids and polyps: removal by hysteroscopy or myomectomy where they are affecting the womb cavity
- Endometriosis: laparoscopic treatment can improve both pain and fertility in appropriate cases
- Tubal problems and unexplained infertility: assisted conception such as IVF, with a referral made to a trusted fertility unit where appropriate
The right plan starts with an accurate diagnosis, which is exactly what the investigations above provide.
Frequently asked questions
What are the first signs you cannot get pregnant?
The clearest sign is not conceiving after 12 months of regular unprotected sex, or 6 months if you are 35 or over. Warning signs include irregular or absent periods, very painful or very heavy periods, pain during sex and hormonal symptoms such as acne or excess facial hair. Many women have no signs at all, which is why fertility testing is the only way to know for certain.
What are the three main causes of female infertility?
The three biggest causes are ovulation problems (most often PCOS), blocked or damaged fallopian tubes and conditions affecting the womb such as fibroids, polyps or endometriosis. Age-related decline in egg number and quality sits alongside all three and is the main factor in how quickly investigation should happen.
Does an irregular period mean I am infertile?
Not necessarily, but irregular cycles usually mean ovulation is irregular, which makes conception harder and is the most treatable cause of female infertility. Cycles consistently shorter than 21 days or longer than 35 days are worth investigating, especially if you are trying to conceive.
Can stress cause female infertility?
Everyday stress does not cause infertility on its own, although severe chronic stress can disrupt ovulation in some women. Stress more often affects fertility indirectly through sleep, weight and how often couples have sex. A physical cause should always be looked for rather than attributing difficulty conceiving to stress.
At what age does female fertility decline?
Fertility declines gradually from around 30 and more steeply from 35 onwards, because both the number and quality of eggs fall with age. This is why guidance recommends seeking assessment after 6 months of trying if you are 35 or over, rather than waiting a full year.
Can PCOS cause infertility?
PCOS is the most common cause of ovulation problems and therefore one of the most common causes of female infertility. The good news is that it is also one of the most treatable. Weight management and ovulation induction medication restore ovulation for most women with PCOS.
Does endometriosis mean I cannot have children?
No. Many women with endometriosis conceive naturally. However, endometriosis can reduce fertility by distorting pelvic anatomy, affecting the ovaries and causing inflammation. If you have endometriosis and are struggling to conceive, seek assessment early because treatment can improve fertility in appropriate cases.
How is female infertility tested?
Standard testing includes blood tests for ovulation hormones, thyroid function, prolactin and AMH, a transvaginal ultrasound scan of the ovaries and womb, follicle tracking to confirm ovulation and tubal patency testing where indicated. A semen analysis for your partner is an essential part of every fertility work-up.
What is AMH and what does it tell you?
AMH (anti-Mullerian hormone) is a blood test that reflects your remaining egg reserve. A lower AMH suggests a reduced reserve and a higher AMH is common in PCOS. It does not predict natural conception on its own, but it helps guide how urgently to act and which treatments are most appropriate.
What is secondary infertility?
Secondary infertility is difficulty conceiving after previously having a baby without problems. It is at least as common as primary infertility. New factors such as age, pelvic infection, surgery, endometriosis progression or weight change can all contribute, and it deserves the same prompt investigation.
Can female infertility be cured?
Many causes of female infertility are fully treatable. Ovulation problems usually respond to medication and lifestyle change, polyps and some fibroids can be removed, and hormone problems can be corrected. Where a cause cannot be fixed directly, assisted conception such as IVF offers an effective route to pregnancy for many couples.
How quickly can I be seen for fertility concerns at a private clinic?
At Ovara Health in Chelsea, same-week appointments are usually available and no GP referral is needed. Consultation, blood tests and a transvaginal ultrasound scan can typically be arranged promptly, so you get answers within weeks rather than months.
Sources and further reading
- NHS: Infertility
- NICE Guideline CG156: Fertility Problems Assessment and Treatment
- HFEA: Human Fertilisation and Embryology Authority
- RCOG: Fertility Patient Information
This article is for general information only and does not constitute medical advice. It is not a substitute for assessment by a qualified clinician.
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Written by Kerry Archer. Medically reviewed by Mr Amer Raza MBBS MRCOG, Consultant Gynaecologist (GMC 5205372). Last reviewed: 2 July 2026.