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Female infertility
Other Resources UpToDate PubMed

Female infertility

Contributors: Hallie Nelson MD, Mitchell Linder MD
Other Resources UpToDate PubMed


Infertility is defined as the inability to spontaneously conceive with regular intercourse over a period of at least 1 year. Prevalence of overall couples with infertility is 15%.

Primary infertility is when a woman has never been pregnant (nulliparous). Prevalence of primary infertility increases with age: women aged 15-34 years (7.3%-9%), aged 35-39 years (25%), and aged 40-44 years (30%).

Secondary infertility occurs when a woman has previously been pregnant and delivered a baby but is now experiencing infertility.

Causes of infertility can be broken down into the following factors based on population data. These factors are present in both primary and secondary infertility:
  • Male factor (hypogonadism, post-testicular defects, seminiferous tubule dysfunction) – 26%-50%
  • Ovulatory dysfunction (anovulation, polycystic ovarian syndrome [PCOS]) – 21%
  • Tubal damage (pelvic inflammatory disease) – 14%
  • Endometriosis (scar tissue affecting the fallopian tubes) – 6%
  • Coital problems (psychological, marital discord) – 6%
  • Cervical factor (cervical stenosis) – 3%
  • Unexplained – 28%-30%


N97.9 – Female infertility, unspecified

6738008 – Female infertility

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Endometriosis – pelvic pain, pain with intercourse, painful menses
  • Thyroid disease (hyperthyroidism and hypothyroidism) – hot flashes, brittle hair / nails, rule out with thyrotropin (TSH)  
  • Male factor – rule out with semen analysis
  • Prolactinomagalactorrhea, rule out with prolactin level (fasting, without nipple stimulation for 12 hours prior)
  • Obesity – peripheral estrogen conversion shutting down HPO (hypothalamic-pituitary-ovarian) axis
  • PCOS – hirsutism, acne, transvaginal ultrasound (TVUS) with high antral follicle count (AFC), elevated anti-müllerian hormone (AMH)
  • Anovulatory cycles – confirm ovulation with ovulation predictor kit
Be careful of ovarian hyperstimulation syndrome (OHSS) if overstimulating the ovary (shortness of breath, palpitations, enlarged painful ovaries).

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:05/17/2021
Last Updated:05/23/2021
Copyright © 2022 VisualDx®. All rights reserved.
Female infertility
A medical illustration showing key findings of Female infertility : Amenorrhea, Pelvic pain, Hirsutism, Hyperprolactinemia, Dysmenorrhea, Dyspareunia
Copyright © 2022 VisualDx®. All rights reserved.