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Causes and Tests of Female Fertility

A woman’s fertility declines substantially by age 32 and even more so after age 40. Infertility occurs because an egg may not be produced, or once released (ovulation), it may not get to the womb, sperm may not reach it, or a fertilised egg may fail to develop.

Common reasons for female infertility include:

A woman’s fertility may also be affected by factors such as fluctuating or diminished hormone levels; inconsistent ovulation; or a poor reproductive environment that does not support proper fertilisation of the egg, interferes with the sperm’s transport, or impairs retention of a fertilised egg.

The initial evaluation of a woman’s fertility includes a personal and family history with a thorough physical examination. The body mass index (BMI) of the female partner is important as being over or under-weight can influence fertility.

A number of tests can be used to help diagnose the problem and aid in treatment.

Initial investigations may include some blood tests, such as measuring the levels of hormones involved in reproduction: luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), oestradiol, and progesterone. The corpus luteum created after ovulation produces progesterone. A raised (>30 nmol/L) serum progesterone measured 7 days prior to the estimated date of the next period is considered a reliable test of ovulation.

Other measurements which can help include thyroid function tests (TSH and/or FT4), steriods such as testosterone and Dehydroepiandrosterone sulphate (DHEAS), is used in creating androgens and oestrogens) and Sex hormone binding globulin (SHBG) which determines the free and thus active level of the sex hormones. Anti-mullerian hormone (AMH) is under investigation as an indicator of ovarian reserve.

These tests help to check the health of the pituitary, thyroid and adrenal glands which can themselves affect the menstrual cycle and ovulation. Further investigations may be undertaken in specialist clinics and may include imaging techniques such as ultrasound (US) to look at individual reproductive organs.

Non-laboratory investigations

Assessment of tubal patency is investigated by Hysterosalpingography (HSG) or laparoscopy or ultrasound.  Ultrasound scanning of the pelvic organs may be used e.g. of the ovaries if anovulation is diagnosed or PCOS is suspected.


Last Review Date: April 27, 2023