Signs of infertility in women
Most women with difficulty conceiving have no symptoms at all beyond not becoming pregnant. That is worth saying first, because absence of symptoms is often taken as reassurance that nothing is wrong.
Signs that warrant assessment
Irregular or absent periods. The clearest signal, because it usually means ovulation is irregular or absent. Under FIGO terminology, normal menstrual frequency is 24 to 38 days — note this replaced the older 21 to 35 day definition still quoted in many places.
Severe period pain that affects your life, is worsening, lasts beyond the first day or two, or comes with pain during sex or on opening bowels. This points toward endometriosis, where the average diagnostic delay is measured in years, largely because severe period pain gets normalised.
Heavy bleeding — soaking a pad or tampon in under two hours, clots larger than a 10-rupee coin, or bleeding through to clothing.
Pain during sex, particularly deep pain.
Signs of raised androgens — persistent acne along the jawline and chin, excess hair growth in a male pattern. With irregular cycles, this suggests PCOS.
Recurrent miscarriage — two or more losses warrants evaluation.
Symptoms of thyroid problems or raised prolactin — including milky nipple discharge, which should always be mentioned.
Signs that something has changed
A sudden reduction in menstrual flow, particularly after a uterine procedure. Periods becoming markedly irregular when they were regular. Hot flushes or night sweats before 40 — which may indicate premature ovarian insufficiency, where diagnosis now requires only one raised FSH above 25 IU.
What is not a reliable sign
Whether you "feel" fertile. Cycle length alone within the normal range. Whether you have had a previous pregnancy — secondary infertility is common.
The point that matters most
Blocked tubes, reduced ovarian reserve and male factor frequently produce no symptoms whatsoever. You cannot rule these out by feeling well.
So the trigger for assessment is time trying, not symptoms: 12 months under 35, 6 months at 35 or over, sooner with any of the signs above.
And male factor
Male factor is involved in a substantial proportion of cases and typically causes no symptoms at all. A semen analysis should be among the first tests, not something arranged after the female partner has been fully investigated.
Sources
- ESHRE/ASRM/CRE-WHiRL/IMS — Premature Ovarian Insufficiency guideline (2025)
Frequently Asked Questions
How do you know if you are infertile as a woman?▾
There are often no obvious signs. Certain symptoms warrant earlier investigation: irregular or absent periods, severe progressive period pain, deep pain during sex, excess hair or acne (PCOS signs), previous STIs or ectopic pregnancy, two or more miscarriages. However, many women with significant fertility issues have no symptoms at all — which is why a fertility workup (not just observation) is the only reliable way to assess fertility.
Can you have regular periods and still be infertile?▾
Yes. Regular periods confirm ovulation is probably occurring, but infertility can still be present from: blocked tubes, endometriosis, uterine abnormalities, poor egg quality due to age, or male factor. A complete fertility workup covers far more than cycle regularity.
Does PCOS mean I cannot get pregnant?▾
No. PCOS is the most common cause of ovulatory infertility, but most women with PCOS can conceive with treatment. Letrozole (first-line per PCOS 2023 guideline) restores ovulation in most cases. Many women with PCOS also conceive naturally, particularly with weight management and inositol supplementation.