14 Possible Signs of Infertility

Infertility is a common issue with as many as 19% of couples having problems conceiving their first child. While, for some, these struggles with infertility occur without any outward signs, in other cases, there are key indicators that something may be amiss and that conception could be more challenging.

Clinically speaking, infertility is defined as the inability to conceive after one year of trying to get pregnant. However, for birthing people ages 35 and up, health care professionals will often treat fertility issues after only six months of trying to conceive.

If you are actively trying to have a baby and not having much luck, it can be helpful to know what potential infertility issues to be on the lookout for. These signs could mean it's less likely you will conceive without intervention, and it might be worth reaching out to a health care provider sooner than later. Here are some potential signs of infertility to be aware of.

Irregular Menstrual Cycle

Having a regular period every 21 to 35 days usually signals that ovulation is taking place; you can track ovulation with an online calculator. But if you are not getting your period on a consistent basis, this could be a sign of infertility or an underlying health issue and a reason to see a health care provider. Even if you have only been trying to get pregnant for a short period of time, you should be evaluated if your periods are irregular.

“Individuals with irregular periods, those who skip menses, or those who lack a menstrual cycle should be evaluated sooner,” suggests Jill Attaman, MD, a board-certified reproductive endocrinologist at Boston IVF and an associate professor at Harvard Medical School. “These could be signs that an egg is not being released at the expected time each month, which makes it challenging to conceive.” 

Menstrual irregularities can occur for a variety of reasons, Dr. Attaman adds. Some possibilities for this dysregulation occur because of polycystic ovarian syndrome (PCOS), abnormal hormone signals to/from the ovary, depletion of eggs, or other endocrine factors. Also, if you have known factors that predispose you to early menopause you may want to get evaluated early on as well, she says.

Heavy Periods or No Periods

Like irregular periods, those who miss periods may have difficulty with getting pregnant due to not ovulating predictably, says Sheila Ramgopal, MD, an OB-GYN with ma(+)e fertility in Pittsburgh and Allegheny Reproductive Center. “People with heavy periods may have other issues such as uterine fibroids or polyps that can make it difficult for a pregnancy to implant normally in the uterus.”

Although stopping birth control could impact the frequency and heaviness of your menstrual cycles initially and take a while for your body to adjust, if you have been missing periods longer than a month or two and you are not pregnant—or if you are experiencing really heavy periods—it is important to talk to a health care provider. They can help you identify the root cause of this irregularity.

Hormone Fluctuations

Hormone imbalances occur when there is too much or too little of a specific hormone in your bloodstream, and—depending on the hormone—high or low levels may adversely affect fertility, explains Akis Jain, MD, reproductive and infertility specialist with OhioHealth. Common symptoms of hormone fluctuations are typically seen in changes of your periods, but a person of any sex can experience hormone imbalances. A reproductive endocrinologist can do an evaluation if you suspect that something is just not right. 

Pelvic Pain 

Having chronic pelvic pain does not necessarily mean that infertility is present, Dr. Attaman says. But pelvic pain is often part of disorders that can make fertility challenging. Examples include endometriosis, pelvic infection, fibroids, and ovarian cysts. 

“Endometriosis may make fertility a challenge for a variety of reasons affecting many different aspects of reproduction,” she adds. “Additionally, a history of pelvic infection such as gonorrhea or chlamydia can damage the fallopian tubes.”

But there also is a possibility that pelvic pain is secondary to other causes related to gynecologic health that do not play a significant role in fertility, Dr. Attaman says. Regardless, if you are experiencing significant pelvic pain, it is important to be evaluated by a healthcare provider.

Erectile Dysfunction

Difficulty having or maintaining an erection is a common condition that can potentially impact fertility, Dr. Attaman says. Sometimes, erectile dysfunction may be a signal that hormones are not being produced in the amounts needed. Or, it could indicate the presence of an underlying health concern and an evaluation with a reproductive urologist may be useful.

“Erectile dysfunction [also can be] exacerbated in couples trying to conceive as it leads to greater stress as a couple attempts conception during the days around ovulation,” Dr. Jain says.

For people who experience situational erectile dysfunction due to the anxiety or stress associated with timed intercourse, there is the option of freezing a backup sample of sperm that can be later used for artificial insemination. But if sperm can be successfully delivered to the vagina while the partner is ovulating, this will have no impact on fertility, says Annette Lee, MD, reproductive endocrinologist, and medical director of Third-Party Services at RADfertility, a partner of the CCRM Fertility Network.

“Luckily, erectile dysfunction can be easily treated by medication or artificial insemination if a partner can produce sperm via masturbation,” she adds. 

Issues With Ejaculation

Ejaculatory dysfunction (EjD) is a prevalent sexual disorder. Typically, it occurs in younger people and can lead to low‐volume semen or a difficulty in ejaculating at all.

In either scenario, difficulty with ejaculation can make timed intercourse much less successful and can impact fertility because the sperm won’t be able to connect with the egg in a traditional way, Dr. Lee says. “For men who are taking SSRIs, difficulty with ejaculation can be a side effect.”

If ejaculation is an issue—either due to medications or another issue—it is important to be evaluated. A healthcare professional can help discuss your options with you.

Swollen or Painful Testicles

While it is uncommon to have painful or swollen testicles, experiencing either symptom could be a sign of other underlying issues going on. In these situations, a reproductive urologist can perform a semen analysis and a complete physical examination to determine the cause.

“[Swollen or painful testicles] can signify infection or an inflammatory process, which may lower sperm count,” Dr. Jain says. “These patients should be evaluated and treated accordingly.” 

Toxic Chemical Exposure

If your job involves close contact with toxic chemicals, you might be at greater risk for infertility and decreased sperm health. Farmers, painters, varnishers, metal workers, and welders have all been found to be at risk for reduced fertility. If your job involves toxic chemical contact or high heat conditions, ask your doctor about steps you can take to protect yourself.

Recurrent Miscarriages

Infertility is usually associated with the inability to get pregnant. However, a birthing person who experiences recurrent miscarriages may also need help getting pregnant.

Miscarriage is not uncommon, occurring in nearly 20% of pregnancies. That said, repeated or recurrent miscarriage is not common. Only 1% of birthing people will miscarry three pregnancies in a row. If you’ve had two successive miscarriages, talk to a health care provider.

History of STIs

Sexually transmitted infections (STIs) can also cause infertility. Infection and inflammation from chlamydia or gonorrhea can cause blockage of the fallopian tubes. Not only can this make unassisted pregnancy impossible, it also places a person at an increased risk for an ectopic pregnancy.

Weight Issues

If a person is overweight or underweight, this can impact fertility. In fact, weight plays a role in hormone levels, which could affect both ovulation and sperm count. What’s more, research shows that the risk of infertility is three times higher in obese birthing people than in non-obese birthing people.

“Studies have demonstrated that even if the embryo itself is genetically normal, the chance of implantation is lower, and chance of miscarriage is higher in obese women,” Dr. Lee says. “Meanwhile, significantly underweight women will often stop ovulating and their periods will be irregular or absent. Significantly overweight men may have sperm abnormalities as well.”

Simply put, being overweight or underweight affects your hormones and impacts your reproductive health no matter what your genitals are, Dr. Ramgopal adds. “Weight affects the way that hormones are released and regulated at all levels of our body—from the brain, adrenal glands, and reproductive organs. And if there is an impact at any of these levels in your body, your fertility can be affected.”

Advanced Maternal Age

Having an advanced maternal age could mean that you have a low ovarian reserve—or fewer eggs remaining—which often results in greater obstacles in conceiving. It's important to remember that the older a birthing person gets, the fewer eggs they have, along with lesser quality. An older age also can make miscarriage more common because as people with ovaries age and have less eggs remaining, the likelihood of having healthy embryos decreases, Dr. Jain says. This also can be a cause of recurrent miscarriages.

Lifestyle Factors

How you live your life and the choices you make also can impact your fertility. For this reason, most health care providers recommend avoiding excess alcohol and caffeine, refraining from using recreational drugs or smoking, exercising regularly, and maintaining a healthy weight to improve the chance of conception and decrease the risk of pregnancy complications, Dr. Lee says.

“Scientific data suggests the Mediterranean diet may have a beneficial impact on fertility, along with cutting out processed foods,” she adds. “Focusing on vegetables and fruits, lean proteins, nuts, and lentils, including healthy fats like olive oil and avocado, and reducing red meat are all choices that may be beneficial for chances of conception.”

Medical Conditions

One of the most common medical conditions that can lead to infertility is PCOS, Dr. Attaman says. “This condition results in a disordered ovulation of eggs and is often associated with impaired metabolic health (such as diabetes or high cholesterol).”

A prior infection that damages the fallopian tubes also could lead to infertility, she adds. “This could lead to damage in, or blockage of, the tube and could limit the egg and sperm from meeting one another.” 

Even having cancer can impact fertility. Treatment often requires medications or radiation that can harm the ovaries, egg quantity, and the health of the uterus or sperm, Dr. Attaman adds. If you have any underlying medical condition, it is important to meet with a health care provider prior to getting pregnant to determine the best course of action given your medical history.

“No matter the age of our patients, physicians always try to address immediate concerns as well as their long-term goals for family size and discuss how we can maximize the possibility of giving our patients the family they want to have, whether that be through IVF or other methods,” Dr. Lee says. 

As always, if you find yourself with lingering questions about your fertility, be sure to reach out to an OB-GYN or health care provider.

Additional reporting by Rachel Gurevich, RN.