Female infertility: causes and tests

Trying for a baby and not conceiving is one of the loneliest experiences a woman can go through. In many Nigerian families the pressure falls almost entirely on the woman, and she is blamed long before anyone has actually checked. That is unfair, and it is also inaccurate. Infertility is a couple's problem, and in a large share of cases the cause involves the man, or both partners, or nothing that can be blamed on anyone.

This article explains what doctors mean by infertility, the common causes in women, the tests that actually matter, and what to expect from the process. It will not give you a diagnosis, but it will help you ask the right questions and avoid wasting money on tests and treatments that do nothing.

What infertility means

Doctors usually consider a couple to have infertility when pregnancy has not happened after a year of regular unprotected sex. Two things about that definition are worth noting. First, it is about a couple, not just a woman. Second, the one-year mark is a guide, not a rule. Some couples conceive naturally in the second year without any treatment.

Age changes the picture. A woman under 35 is usually advised to seek help after a year. A woman over 35 may be advised to seek help sooner, often after six months, because fertility falls with age and time matters. If periods are very irregular or absent, or if there is a known problem such as previous pelvic infection or endometriosis, do not wait the full year. Go earlier.

Common causes in women

Ovulation problems are among the most common causes. If you are not releasing an egg regularly, there is nothing for sperm to meet. This can happen with polycystic ovary syndrome (PCOS), with thyroid problems, with very low or very high body weight, or with excessive exercise and stress. It often shows up as irregular, very infrequent, or absent periods.

Blocked or damaged fallopian tubes are another major cause. Previous pelvic inflammatory disease, a past ectopic pregnancy, endometriosis, or prior pelvic surgery can scar the tubes. When the tubes are blocked, the egg and sperm cannot meet. This is common in Nigeria, where pelvic infection is frequent and sometimes treated late.

Endometriosis, where tissue similar to the womb lining grows outside it, can distort the pelvis and affect both the tubes and the ovaries. Fibroids can sometimes interfere with implantation, depending on their size and position. Problems with the uterus itself, such as a septum or scar tissue from previous procedures, can also play a role. And age is a factor in its own right, because the number and quality of eggs fall over time.

In many couples no single cause is found, and both partners contribute a little. That is normal, not a mystery failure.

Tests that matter

The right tests are targeted, not a scattergun of everything on offer. A sensible basic assessment for the woman includes the following.

A clear history and examination come first, including your periods, previous pregnancies, infections, surgeries, and any family history. The doctor will also ask about your partner, because his assessment is equally important.

Blood tests look for ovulation and its causes. A hormone panel can assess ovarian function and check the thyroid and prolactin, both of which can disturb ovulation. Some of these blood tests are timed to the first days of your cycle, so the clinic will tell you which day to come.

An ultrasound scan looks at the womb, the ovaries, and the follicles, and can show fibroids, cysts, or other structural issues.

Tests of the fallopian tubes check whether they are open. There are different methods, and your doctor will pick the one suited to you. This test can be uncomfortable, but it is important because blocked tubes change everything that follows.

An early test for your partner is his semen analysis. It is simple, quick, and inexpensive compared to many female tests, and it often reveals the answer. Skipping it wastes time and money. It should be done early, not as a last resort.

Tests that are often unnecessary

Not every test helps. Some clinics order batteries of hormone panels that do not change the plan. Others offer treatments before the basics are done. Ask what each test will change, and if the answer is nothing, question it. Reserve genetic and specialised tests for the situations where the history points to them.

What the process feels like, and how to cope

The investigation phase is often emotionally harder than the treatment. There is waiting, repeated appointments, and well-meaning relatives asking when the baby is coming. It is common for couples to feel strained, and for the woman to carry blame that is not hers.

It helps to go to appointments together. It helps to agree in advance how much you will spend and how far you will go, because costs can climb quickly and decisions made in desperation are often regretted. Many Nigerian couples face high out-of-pocket costs, since fertility treatment is usually not covered by NHIA or HMO plans, so budget planning is part of the medical plan.

If you feel low, anxious, or unable to sleep, talk to your doctor. That is a medical concern too.

When to seek help, and when it is urgent

See a doctor to start an assessment if you have been trying for a year, or after six months if you are over 35. See one sooner if your periods are very irregular or absent, if you have had pelvic infection or a previous ectopic pregnancy, if you have severe period pain, or if your partner has known issues.

There is little that is urgent in infertility, but some symptoms are. Seek urgent care if you have:

• Sudden severe lower abdominal pain with a missed period, or pain with fainting, which may be an ectopic pregnancy.
• Heavy vaginal bleeding.
• Fever with pelvic pain and a foul discharge.
• Severe pain that is getting worse.

These need same-day assessment and are not part of routine fertility workup.

Next steps

If you and your partner have been trying without success, book a joint appointment rather than putting it off. Ask for the basic assessment for both of you, including a semen analysis, before agreeing to any expensive treatment. Bring your questions and your budget, and do not accept blame for a problem that belongs to the couple. For any of the urgent signs above, seek care immediately.

Related articles

• IVF in Nigeria: what to expect (ivf-in-nigeria)
• Polycystic ovary syndrome (PCOS): what it is and how it is managed (pcos)
• Endometriosis: causes and treatment (endometriosis)
• Pelvic inflammatory disease (PID): symptoms and fertility (pelvic-inflammatory-disease)