Female infertility: causes, tests, treatment and which doctor to see
When to seek help for difficulty getting pregnant, the common causes in women, the tests both partners need, and treatments from ovulation tablets to IVF.
Also known as: Infertility, Female
What infertility is
Infertility means not becoming pregnant after a year of regular unprotected sex. Doctors advise seeking help sooner — after six months of trying — if the woman is 35 or older, or straight away if periods are absent or very irregular, there is a known problem such as endometriosis, or the male partner has a known problem.
Infertility is a medical condition, not a personal failing, and it is common. Problems may lie with the woman, the man, both, or neither that can be identified. In India, the woman is often blamed and tested first, but both partners should be assessed together from the start.
Many couples go on to have children, some naturally and some with treatment. The woman's age is the single biggest factor in fertility, because the number and quality of eggs fall over time, so it is worth seeking help without long delays.
Symptoms and signs
The main sign is difficulty getting pregnant. Some women also have symptoms that point to a cause:
- Irregular periods, or absent periods, suggesting that eggs are not being released
- Painful periods or pain during sex, which may suggest endometriosis
- Excess facial hair, acne and weight gain, as in polycystic ovary syndrome (PCOS)
- Milky discharge from the nipples, which can come from a high prolactin level
- Hot flushes or periods stopping early, which can mean the ovaries are failing early
Causes and who is at risk in India
Common causes in women include:
- Ovulation problems — PCOS is the commonest; thyroid disorders, high prolactin, being very underweight or overweight, and premature ovarian insufficiency also play a part
- Blocked or damaged fallopian tubes — from pelvic infections, past surgery, endometriosis or genital tuberculosis, which remains an important cause in India
- Endometriosis
- Problems in the womb — fibroids, polyps, scarring inside the womb or a uterine septum
- Age, particularly from the mid-thirties onwards
Smoking, heavy alcohol use, very intense exercise, stress and some medicines can also reduce fertility. Infections passed through sex can damage the tubes silently, so prompt treatment of pelvic infections matters.
How it is diagnosed
Assessment covers both partners. For the woman, common tests include:
- Ovulation tests — a blood progesterone test in the second half of the cycle, or tracking with scans
- Hormone tests, including thyroid, prolactin, FSH and AMH, which gives a guide to the ovaries' egg reserve
- Pelvic ultrasound, usually transvaginal, to check the womb and ovaries and count follicles
- HSG (hysterosalpingogram) — an X-ray with dye to check whether the tubes are open — or a similar ultrasound test
- Hysteroscopy to look inside the womb, and laparoscopy to look at the tubes and pelvis when needed
Semen analysis for the male partner is one of the first and simplest tests, and should not be left until after the woman has had invasive tests. Your doctor will interpret AMH and other results in the context of your age; a low AMH does not on its own mean you cannot conceive.
Which doctor to see
A gynaecologist can begin assessment and treat many causes. A fertility specialist (reproductive medicine) manages IUI, IVF and complex cases. An endocrinologist helps with thyroid, prolactin and other hormone problems, and the male partner may need a urologist or andrologist.
Under the Assisted Reproductive Technology (Regulation) Act, 2021, every clinic and bank offering assisted reproduction must be registered with the National Registry of Banks and Clinics of India. Ask to see a clinic's registration before starting treatment. You can find gynaecologists in Bengaluru on The Doctor Index, each with a registration you can check.
Treatment
Treatment depends on the cause, the woman's age, how long the couple has been trying and the male partner's results.
- Ovulation induction — tablets such as letrozole or clomiphene, or injections, to help release an egg, with scans to monitor response and reduce the risk of twins or triplets
- Treating thyroid or prolactin problems, and support with weight change where relevant
- Surgery — hysteroscopy to remove polyps, fibroids or scarring inside the womb, or laparoscopy for endometriosis or tubal problems
- IUI (intrauterine insemination) — prepared sperm placed in the womb around ovulation
- IVF (in vitro fertilisation) — eggs collected and fertilised in a laboratory, with an embryo placed in the womb. ICSI, in which a single sperm is injected into each egg, is used for male-factor problems. Donor eggs are an option in some situations.
IVF and IUI are forms of assisted reproductive technology (ART). Ask about the number of cycles recommended, the risks, including ovarian hyperstimulation and multiple pregnancy, and the full plan before you start. Do not take fertility tablets without a doctor monitoring you.
Living with it: looking after yourselves
- Start folic acid before trying to conceive, as your doctor advises
- Stop smoking and limit alcohol, for both partners
- Aim for a healthy weight and regular activity
- Have sex regularly through the cycle rather than only on predicted fertile days
- Seek counselling or support — infertility is stressful, and family pressure can make it harder
When it is an emergency
Call 112 or 108, or go to the nearest emergency department, for:
- Pain on one side of the lower abdomen, bleeding or fainting with a positive pregnancy test — possible ectopic pregnancy
- During fertility treatment: rapid swelling of the abdomen, severe pain, breathlessness or passing very little urine
- Sudden severe pelvic pain with vomiting
Questions to ask at your appointment
- Which tests do we both need, and in what order?
- Am I ovulating, and are my tubes open?
- What do my AMH and scan results mean for my age?
- What treatment do you recommend first, and for how long?
- Is this clinic registered under the ART Act?
- What are the risks, and what happens if the first plan does not work?
Common questions
Questions people ask
- When should we see a doctor about not getting pregnant?
- After a year of regular unprotected sex, or after six months if the woman is 35 or older. See a doctor straight away if periods are absent or very irregular, there is known endometriosis or past pelvic infection, or the male partner has a known problem.
- Is infertility always the woman's problem?
- No. Problems in the male partner are just as common, and sometimes both partners have a problem or no cause is found. A semen analysis is a simple early test, and both partners should be assessed together from the beginning.
- Is IVF the only option for infertility?
- No. Many couples conceive with simpler treatment, such as ovulation tablets, treating a thyroid problem, surgery or IUI. IVF is recommended when tubes are blocked, there is significant male-factor infertility, or other treatments have not worked.
- How do I know a fertility clinic is legitimate?
- Under the Assisted Reproductive Technology (Regulation) Act, 2021, ART clinics must be registered with the National Registry of Banks and Clinics of India. Ask for the registration, the doctors' qualifications and a clear written plan before starting treatment.
This condition is usually assessed by a gynaecologist. Every profile shows the doctor’s registration and what has been checked.
Gynaecologists in Bangalore
A few gynaecologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Female Infertility; ask the clinic whether the doctor sees it.
Related conditions
All reproductive medicine conditions →
Practical reading
All postsSources
- MedlinePlus, US National Library of Medicine — Female Infertility
- World Health Organization — Infertility fact sheet
- National Medical Journal of India — Legal subtleties of the Indian Assisted Reproductive Technology Act of 2021
- MedlinePlus, National Library of Medicine — Female Infertility — Public-domain health-topic summary
- Human Phenotype Ontology Consortium — terminology definitions — HPO licence; definitions reproduced without alteration
Female infertility: causes, tests, treatment and which doctor to see is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-0926.