How to Know if You're Infertile: A Complete Guide for Couples Struggling With Conception
How to know if you're infertile? Find out the signs, diagnostic tests, and expert tips to help you navigate your fertility concerns.
Struggling to conceive can feel overwhelming and leave you with many unanswered questions. When pregnancy doesn’t happen as expected, it’s natural to wonder if something is wrong. In many cases, these concerns lead to questions about infertility.
There are numerous causes of infertility in both men and women. While it can feel isolating, it's more common than many realize.
In this article, we’ll explore the signs of infertility, helping you understand when it's time to seek professional help and take the next steps on your fertility journey.
What Is Infertility?
Infertility refers to the inability to conceive or carry a pregnancy to term despite regular, unprotected sexual activity for 12 months for couples under 35. For those 35 and older, the timeframe is shortened to six months. According to the WHO, about 1 in 6 adults worldwide, or 17.5% of the population, face infertility.
Infertility is classified into two main categories: primary and secondary.
Primary infertility refers to couples who have never been able to conceive. Secondary infertility occurs when a couple has previously conceived but now struggles to get pregnant again. In the U.S., roughly 1 in 5 women aged 15 to 49 face primary infertility, and about 1 in 20 experience secondary infertility.
Common Misconceptions About Infertility
One widespread myth is that infertility only affects women, but that’s not true.
Male factors are responsible for 20% of infertility cases, and they play a role in 30-40% more, often in combination with female factors. Therefore, both partners should undergo testing to get a full picture of potential fertility issues.
Another common misconception is that infertility is always linked to age. While it’s true that age affects fertility in both men and women, it’s not the only factor. Infertility can occur at any age and is influenced by many other factors, including lifestyle, health conditions, and environmental factors.
Signs of Infertility in Women
The most common signs of female infertility usually involve changes in your menstrual cycle. Here are some signs to watch for:
- Heavier or lighter periods.
- Periods that come at unpredictable times.
- Amenorrhea, or periods that stop suddenly or never start.
- Dysmenorrhea, or painful period cramps.
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You might also notice signs and symptoms related to hormonal changes. Hormonal imbalances can lead to acne and other skin changes, excessive facial and body hair (hirsutism), hair loss, and weight gain.
But take note: experiencing these symptoms doesn’t always mean you’re infertile.
Pregnancy Test showing a negative result
Are Painful Periods a Sign of Good Fertility?
While mild cramping is normal, extreme discomfort shouldn’t be ignored. Painful periods are not necessarily a sign of good fertility. This is because dysmenorrhea can be a symptom of conditions like endometriosis.
Endometriosis is a condition where tissue similar to the lining of your uterus grows outside the uterus. You might experience severe pain, heavy periods, and in extreme cases, infertility. Endometriosis affects 25–50% of women struggling with infertility, and 30–50% of women with endometriosis have trouble getting pregnant.
Signs of Infertility in Men
Compared to infertility in women, male infertility has no obvious symptoms. It can be hard to notice until you’re actively trying to conceive. Below are some common signs and symptoms that may point to male infertility:
- Reduced facial or body hair.
- Low libido.
- Reduced muscle mass.
- Difficulty maintaining an erection or erectile dysfunction.
- Pain or swelling in testicles.
- Difficulty ejaculating or low semen volume.
If you notice any of these signs, getting tested and consulting a fertility specialist can lead to treatments or interventions that significantly improve the chances of your success. But just like in women, these symptoms don’t always mean a man is infertile.
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How to Know If You Are Infertile
We know that you might be anxious about infertility testing. Fortunately, modern medicine has made it easier to diagnose and treat the many causes of infertility.
Fertility Tests for Women
So, how do we test if a woman is infertile?
Infertility tests for women involve a combination of tests that aim to assess the health of your reproductive organs, hormone levels, and overall fertility potential.
Ovarian Reserve Test
This test evaluates the number and quality of a woman’s eggs. Doctors often measure hormones like FSH (Follicle-Stimulating Hormone) and AMH (Anti-Müllerian Hormone). High FSH levels and low AMH levels can suggest a lower egg count.
Another part of this test is the Antral Follicle Count (AFC), which uses an ultrasound to look at the number of small follicles in your ovaries. Doctors usually perform this test on the 3rd day of your cycle. A lower count may indicate fewer eggs available for fertilization.
Hormone Level Blood Tests
Hormones have a strong influence on fertility, and these tests measure several key hormones that affect ovulation and reproductive health. Low estrogen levels can indicate problems with the ovaries or pituitary gland. Meanwhile, low progesterone may signal that ovulation hasn’t occurred properly.
Thyroid imbalances, such as hypothyroidism or hyperthyroidism, can also interfere with your reproductive health.
Imaging
Imaging tests will help your doctor examine your reproductive organs to identify issues affecting fertility. These tests will check if your ovaries, uterus, and fallopian tubes are healthy enough to support pregnancy.
The most common imaging test is the transvaginal ultrasound. It helps detect problems such as cysts, fibroids, or other abnormalities.
Next, is hysterosalpingography. In this X-ray procedure, doctors inject a contrast dye into your uterus and take images to check for blockages or abnormalities in the fallopian tubes. If the dye doesn’t flow freely, your fallopian tubes may be blocked.
Doctors can also perform hysteroscopy or laparoscopy. Hysteroscopy involves inserting a thin, lighted tube through your cervix and into the uterus to check for issues like polyps, fibroids, or scarring. On the other hand, laparoscopy uses a small camera inserted into your abdomen to check for conditions like endometriosis or pelvic adhesions.
Fertility Tests for Men
Fertility tests for men commonly involve semen analysis. This test checks:
- Sperm count: The total number of sperm.
- Motility: How well the sperm moves.
- Morphology: The size and shape of the sperm.
- Semen volume: The amount of semen available for sperm transport.
Abnormalities in any of these factors can make it harder for sperm to reach and fertilize an egg.
Doctors also perform hormonal blood tests to measure testosterone and other hormones involved in sperm production.
Finally, a physical examination by a urologist can identify structural issues like varicoceles (enlarged veins in the scrotum) or blockages that may affect fertility.
A male's hand is holding a plastic jar with a sperm analysis
Common Reasons for Infertility When Everything Seems Normal
Sometimes, despite fertility tests coming back normal, couples still face infertility. Clinicians call this “unexplained infertility”, and affects 15% of infertile couples.
This can be frustrating, but underlying factors may be at play.
Some health conditions, though not immediately obvious, can impact your infertility. Diabetes and hypertension, for example, can reduce fertility rates in both men and women.
Even if you’re healthy and active, external factors can still impact fertility:
- Stress. Chronic stress can affect hormone levels. According to a 2018 study, stress-related hormone changes can delay ovulation and egg maturation.
- Age. For women, fertility starts to decline in their 30s as both the number and quality of eggs decrease, making conception more difficult. Men also experience a gradual decline in fertility starting around age 40, with reduced sperm count and quality.
- Smoking. Smoking also affects male and female fertility. According to a study, 13% of female infertility cases may be due to smoking. In men, smoking can decrease sperm concentration by up to 22%.
- Diet. Poor nutrition, being underweight or overweight, or a lack of essential nutrients can disrupt reproductive health. Obese women, for example, show a threefold higher risk of infertility compared to women with normal BMI. Excessive caffeine or alcohol intake may also play a role.
- Environmental Toxins. Exposure to chemicals or pollutants can harm both male and female fertility. For example, endocrine-disrupting chemicals in plastics, pesticides, or heavy metals may affect hormone levels.
Persistent infertility symptoms, even when everything seems normal, can signal a need for further evaluation.
When to Seek Professional Help
If you’ve been trying to get pregnant for over a year (or six months if you're 35 or older) without success, it might be time to talk to a healthcare provider or fertility specialist. Even if you’re feeling uncertain, seeking help can give you the support you need.
A fertility expert can offer advice on treatments, lifestyle changes, and ways to improve your chances of conceiving. If these steps don’t help, they can guide you through options like IUI or IVF.
Wrapping It Up
Facing infertility can be an emotionally challenging journey, but it’s important to remember that you’re not alone. Support is always within reach. Recognizing the signs of infertility is a crucial first step in seeking help. Medical professionals can provide personalized guidance, recommend the right tests, and help you uncover the underlying causes of your fertility challenges.
If your efforts to conceive have not been successful, don’t hesitate to reach out to a healthcare provider or fertility specialist. Today’s advanced treatments offer hope and pathways to achieving your dream of starting a family.
Raoul Angelo Cam is a freelance health content writer and a registered clinical laboratory scientist. He earned his degree in Clinical Laboratory Sciences from Cebu Doctor’s University and completed three years of medical school. During university, he developed a passion for helping patients improve their well-being, including reproductive health and fertility.