Infertility in Women — Causes, Signs & When to See a Doctor | Dr. Chetna Jain, Gynaecologist Gurgaon

Infertility is defined as the inability to conceive after twelve months of regular, unprotected intercourse — or after six months if the woman is aged 35 or above. It is far more common than most people realise. Studies estimate that infertility affects approximately one in six couples in India, and in nearly half of all cases, a female factor is either wholly or partially responsible. Yet despite its prevalence, infertility remains one of the most emotionally isolating and least openly discussed health challenges a woman can face.

I am Dr. Chetna Jain, a senior gynaecologist in Gurgaon, and in this blog I want to give you a clear, honest overview of the most common causes of female infertility, the signs that warrant early investigation, and — most importantly — when to stop waiting and seek expert help.

The Most Common Causes of Female Infertility

Female infertility is rarely a single, isolated problem. It is most often the result of one or more underlying conditions affecting ovulation, the reproductive anatomy, or hormonal balance. Here are the most frequently encountered causes in my clinical practice in Gurgaon:

1. Ovulation Disorders

Ovulatory dysfunction is the single most common cause of female infertility, accounting for approximately 25 to 30 percent of cases. Without ovulation, there is no egg available for fertilisation. The most frequent cause of ovulation problems is PCOS (Polycystic Ovary Syndrome), which disrupts the hormonal signals that trigger egg release. Other causes include thyroid disorders, elevated prolactin levels, premature ovarian insufficiency, and hypothalamic dysfunction caused by extreme weight loss, excessive exercise, or significant psychological stress.

2. Tubal Damage or Blockage

The fallopian tubes carry the egg from the ovary to the uterus and are the site of fertilisation. Damage or blockage of one or both tubes prevents this journey — and is responsible for approximately 20 to 25 percent of female infertility cases. The most common causes of tubal damage include pelvic inflammatory disease (PID) caused by sexually transmitted infections such as Chlamydia or Gonorrhoea, previous pelvic surgery, appendicitis, or endometriosis. Tubal factor infertility is often completely asymptomatic — which is why investigation is so important for women who are not conceiving.

3. Endometriosis

Endometriosis — a condition where uterine lining tissue grows outside the uterus — affects approximately 10 percent of women of reproductive age and is a significant contributor to infertility. It can impair fertility through multiple mechanisms: distorting pelvic anatomy, causing tubal adhesions, damaging ovarian reserve through endometriomas (chocolate cysts), and creating an inflammatory pelvic environment hostile to fertilisation and implantation. Crucially, the severity of endometriosis does not always correlate with symptoms — some women with minimal pain have extensive disease, and vice versa.

4. Uterine and Cervical Factors

Structural abnormalities of the uterus — including fibroids (particularly submucosal fibroids that distort the uterine cavity), polyps, uterine septum, adhesions (Asherman's syndrome), or a congenitally abnormal uterus — can prevent successful implantation of an embryo or increase the risk of miscarriage. Cervical factors, such as poor cervical mucus quality or cervical stenosis, can impair sperm transport.

5. Age-Related Decline in Egg Quality and Quantity

A woman's ovarian reserve — the number and quality of her remaining eggs — naturally declines with age. This decline becomes clinically significant from the early 30s and accelerates sharply after 35. Diminished ovarian reserve means fewer eggs available for fertilisation, a higher proportion of chromosomally abnormal eggs (which leads to failed implantation or miscarriage), and a reduced response to fertility treatment. Age is the single most important independent determinant of female fertility — and one that cannot be reversed, only planned around.

6. Unexplained Infertility

In approximately 10 to 15 percent of infertile couples, a thorough investigation reveals no identifiable cause — a diagnosis known as unexplained infertility. This does not mean nothing is wrong; it reflects the current limitations of diagnostic testing. These couples can still achieve pregnancy with appropriate fertility treatment.

Signs That May Indicate a Fertility Problem

While many women with fertility issues have no symptoms whatsoever, certain signs can point towards an underlying problem that warrants earlier investigation:

• Irregular, infrequent, or absent menstrual periods — suggesting ovulation problems or hormonal imbalance

• Very painful periods or chronic pelvic pain — possible indicators of endometriosis or pelvic adhesions

• A history of pelvic inflammatory disease, STIs, or previous pelvic surgery — raising the possibility of tubal damage

• Recurrent pregnancy loss — two or more consecutive miscarriages — which warrants a dedicated investigation

• Signs of hormonal imbalance — significant weight gain, hair loss, acne, or excessive facial hair — suggesting PCOS or thyroid dysfunction

• Galactorrhoea — unexplained milk discharge from the nipples when not pregnant — suggesting elevated prolactin

The presence of any of these signs is a reason to seek evaluation sooner rather than later — without waiting for the standard twelve-month threshold.

When Should You See a Gynaecologist About Infertility?

The standard clinical guidance is clear, but many women wait far longer than necessary. Here is the timeline I follow at my clinic in Gurgaon:

• Under 35: Seek evaluation after 12 months of regular, unprotected intercourse without conception.

• Age 35 to 40: Seek evaluation after 6 months — egg quality declines meaningfully in this window and time matters.

• Over 40: Seek evaluation immediately — do not wait. Investigation and treatment, if needed, should begin without delay.

• At any age: Seek evaluation immediately if you have irregular periods, a history of pelvic disease or surgery, two or more miscarriages, or any of the clinical signs listed above.

The initial fertility workup is straightforward and non-invasive. At my clinic in Gurgaon, it typically includes a detailed history, a pelvic ultrasound, hormonal blood tests including AMH, FSH, LH, and thyroid function, and a semen analysis for the male partner. Together these investigations give us a comprehensive picture of the likely cause — and the most appropriate next steps.

You Do Not Have to Navigate This Alone

Infertility is one of the most emotionally demanding experiences a woman and a couple can face. The uncertainty, the hope, the disappointment — it is an exhausting cycle. But with the right medical support, the right investigations, and a personalised treatment plan, the majority of couples with fertility challenges do achieve the family they are hoping for.

If you are struggling to conceive and looking for a gynaecologist in Gurgaon who will take your concerns seriously, investigate thoroughly, and guide you with both clinical expertise and genuine compassion — I am here. My clinic serves women from Palam Vihar, DLF, South City, Sector 22, Sector 23, and all of NCR. Book your appointment today. The sooner we start looking for answers, the sooner we find them.

Your path to parenthood starts with one conversation.

— Dr. Chetna Jain | Senior Gynaecologist & Obstetrician | Gurgaon, Haryana