What are the key signs of infertility in women?

It might seem obvious, but the clearest sign of infertility is the inability to get pregnant despite having regular, unprotected sex.

At IVI, we recommend that you consult your GP or a fertility specialist if you find that you have not been able to get pregnant after 12 months of trying to conceive. If you are over the age of 35, you should seek professional help sooner, after six months of trying to conceive.

However, there are also some less obvious warning signs that could alert you to a fertility problem. In this article, we take a closer look at some of the signs and their underlying causes. It is important to bear in mind that if you recognise any of these signs, it’s not a definite diagnosis of infertility: only an indication of the possibility. If you are experiencing symptoms of infertility, please remember that, in the overwhelming majority of cases, these are treatable.

1. Missed periods

A missed period once in a while is actually a fairly common occurrence and is normally nothing to worry about. On the other hand, if your periods stop altogether for a number of months, it is very likely that you are not ovulating and therefore will not be able to get pregnant if you are trying to conceive. This is known as amenorrhea. Other symptoms of amenorrhea can include thinning of the hair or hair loss, pelvic pain, headaches and the growth of excess facial or body hair. Possible causes of amenorrhea include:

• Lifestyle factors: Lifestyle factors such as high stress levels; sudden weight loss (with a resulting BMI of 18.5 or less); sudden weight gain (with a resulting BMI of 30 or over) and extreme exercise or physical exertion, which disrupts your normal fat to muscle ratio, can lead to the cessation of periods.
• Hormonal imbalances: Hormonal changes in the body can result from premature menopause, a malfunction of the thyroid gland or polycystic ovarian syndrome (PCOS) and can present as the loss of periods.
• Certain medication or medical treatments: Some treatments and medications, such as radiotherapy, chemotherapy, antipsychotics, antidepressants and allergy medication can also bring about amenorrhea.

2. Long, heavy or painful periods

Many women experience some routine discomfort or cramping during their period. This is a natural side effect of the endometrial cells inside the uterus releasing prostaglandins, triggering contractions which help to expel its lining. Although painful and sometimes inconvenient, it is not normally a sign that anything is wrong. However, periods that are unusually long, heavy or painful can be a symptom of endometriosis. This is a condition in which tissue similar to the womb lining, known as the endometrium, begins to grow in areas outside of the womb, such as the pelvic cavity. Endometriosis is estimated to affect one in 10 women. Although the condition doesn’t always cause infertility, it can do so if left untreated. It can also hamper efforts when trying to conceive, for example by causing a blockage of the fallopian tubes. Other symptoms of endometriosis can include:

• Chronic pelvic pain that isn’t restricted to a monthly period;
• Pain during sex;
• Pain during bowel movements;
• Nausea and fatigue;
• Irregular periods and spotting between periods.

3. Irregular periods

Period cycles do naturally vary from the standard 28 days, with anything from 21 to 35 days being normal. Similarly, the duration of menstrual flow can vary between two to seven days. If your period is regular and within this range, it is a good indicator that you are ovulating. By contrast, an irregular cycle outside of this range is a signal that you are not ovulating regularly. This can make it difficult or impossible to get pregnant. Irregular periods could be caused by:

• Polycystic ovary syndrome (PCOS);
• Being significantly underweight or overweight;
• Thyroid problems, such as hypothyroidism.

If an irregular period is being caused by a medical condition, it is normally counteracted with hormonal medication such as the oral contraceptives. Once your condition is being treated by hormonal medication, your chances of conceiving naturally should improve significantly.

4. Underlying medical conditions

If you having trouble conceiving, it could stem from an underlying medical condition. Some conditions have symptoms which can be detected in other ways, however others may not be so noticeable until you are trying to conceive. These may include:

Blocked fallopian tubes

Blocked fallopian tubes cause fertility issues by preventing the egg from travelling down the fallopian tube from the ovary. Such blockages prohibit the egg from reaching the sperm to be fertilised and continuing its journey to the uterus. In this case, you would experience infertility despite ovulating regularly and having normal periods. Blocked tubes could result from infections including sexually transmitted diseases, pelvic inflammatory disease or endometriosis.

Damage to the ovaries

The ovaries may be impacted by previous surgery, which can affect the ovarian reserve. Examples include surgery to treat endometriosis, or to remove an ovarian cyst. Essential cancer treatment, such as radiotherapy or chemotherapy, can also damage the reproductive organs and have an irreversible effect on fertility. If you are facing this type of treatment and wish to have children in the future, you should consider preserving your fertility before your treatment begins. This would give you the option of starting a family at a later date. Future family planning is something your doctor will discuss with you when planning your cancer treatment.

Lifestyle factors

While you may not think of lifestyle factors in the same way as underlying medical conditions, they can have a similar impact on your fertility. For example:

• Smoking: Women who smoke are twice as likely to be affected by infertility than those who do not smoke. Even where smoking does not cause infertility, it takes smokers longer to get pregnant than non-smokers. This is because smoking not only depletes the ovarian reserve, it also causes chromosomal damage to the eggs. This means that the chances of conceiving each month are reduced. It also reduces a woman’s window of fertility, with smokers reaching menopause an estimated four years earlier than non-smokers.
• Hormonal imbalance: Your hormone balance regulates your fertility, which can be disrupted if you are overweight. Having a higher proportion of body fat triggers your body to produce excess oestrogen which in turn can affect your menstrual cycle. If you’re trying to get pregnant and have a BMI of over 30, it could be worth getting a referral to a dietician for advice on losing weight safely.

Getting advice about your fertility

If you are trying for a baby and recognise any of these symptoms, it’s best to seek advice. While none of these signs are a certain indicator of infertility, the sooner it is investigated and confirmed, the sooner you can identify if there is a problem and get the help you need.

If in doubt, you should always get in touch with your GP or speak to one of our friendly fertility specialists at IVI.