Infertility Warning Signs
One of the most common questions I get asked is: How will I know if I’m going to have trouble getting pregnant? Can I test my fertility? I want to be pregnant one day, but not now.
One of the hardest things is that while I can test your fertility right now and identify if something is wrong at this moment, none of that guarantees you’ll be able to get pregnant in the future. However, one of the biggest sources of regret I see is when someone has warning signs that something is wrong but didn’t know about them. This can lead to months or even years of trying to conceive when, in reality, they should have sought fertility treatment sooner.
That’s why this is so important. Here are six of the top signs or symptoms that may indicate a higher chance of infertility.
Disclaimer: Some people will have these signs and symptoms and still not have infertility. Nothing is 100%, but this information can help guide you on whether you should seek an evaluation sooner, consider fertility preservation (like egg freezing), or get fertility testing done at an earlier stage.
1. Painful Periods or Painful Intercourse
Painful periods, specifically severe pain during menstruation, or pain with intercourse (especially deep penetration or certain positions), can be a sign of endometriosis. Endometriosis is a chronic inflammatory disorder with an autoimmune component. It causes inflammation and can lead to scarring, which may reduce egg count and make it harder to conceive.
Some people with endometriosis have no symptoms, while others experience debilitating period pain. A good rule of thumb is:
If your periods interfere with daily life—causing you to cancel plans, miss work, or avoid activities—you should be evaluated.
If you experience vomiting or fainting due to period pain, that is NOT normal and may indicate endometriosis.
2. Irregular or Absent Periods
Your period is a vital sign of your reproductive health. If you’re not on hormonal contraception and your periods are not regular and predictable, something may be off. This can include:
Irregular cycles
Skipped months
Abnormal spotting or bleeding
Potential causes include hormone dysfunction, thyroid disease, polycystic ovary syndrome (PCOS), or hypothalamic dysfunction. I’ve seen many cases where someone has been trying to conceive for a year but has only had a few periods—meaning they’ve only had a few chances to get pregnant. If your cycles are not regular, seek an evaluation before trying to conceive.
3. Low Libido or Erectile Dysfunction in Your Partner
For male partners, issues such as low libido or erectile dysfunction can indicate low testosterone levels. Testosterone is produced at the same time as sperm, so low testosterone can also mean low sperm count. If your partner is experiencing these symptoms, a semen analysis should be done earlier rather than later.
Important: If your male partner is taking testosterone supplements, this can act as male birth control and suppress sperm production entirely. This should be addressed before trying to conceive.
4. History of Chlamydia or Gonorrhea
A history of chlamydia or gonorrhea can increase the risk of tubal infertility. These infections can spread from the cervix to the uterus and fallopian tubes, causing scarring and blockages. This can lead to ectopic pregnancies or make natural conception impossible without IVF.
If you have a history of these STIs and are struggling to conceive, a tubal evaluation should be done. This can be performed via:
Hysterosalpingogram (HSG): An X-ray dye test to check if the tubes are open.
Saline Infusion Sonohysterogram (SIS): A water-based ultrasound test for tubal patency.
5. Underweight or Overweight BMI
Your weight plays a crucial role in fertility. Both underweight and overweight individuals may have difficulties conceiving.
Underweight individuals may experience hormonal disruptions that impair ovulation and implantation.
Overweight individuals may experience inflammation and hormonal imbalances that affect egg quality and uterine lining.
Studies on donor egg recipients show that those with a normal BMI have the highest success rates, while those with very low or high BMIs have lower pregnancy rates—even when using high-quality eggs.
If you plan to conceive in the future, working towards a healthy BMI can optimize your fertility.
6. Personal or Family History of Autoimmune Disease
Autoimmune diseases are increasingly common and often take 7–10 years to diagnose. Many women are diagnosed in their mid-30s to mid-40s, meaning they may experience unexplained infertility or recurrent pregnancy loss before receiving a diagnosis.
Autoimmune diseases often run in families. Even if your family members have different conditions, a family history of autoimmune disorders should prompt an earlier evaluation if you’re having trouble conceiving.
When Should You See a Fertility Doctor?
The standard guidelines for seeing a fertility specialist are:
Under 35 years old: If not pregnant after one year of regular, unprotected intercourse.
35 and older: If not pregnant after six months.
40 and older: Ideally, get an evaluation before trying to conceive.
However, these guidelines assume everything is functioning normally. If you have any of the above warning signs, it’s wise to seek an evaluation sooner—before you want to conceive.
What Does Fertility Testing Include?
Basic fertility testing evaluates:
Uterus and fallopian tubes (HSG or SIS)
Egg count (ovarian reserve) through blood tests like AMH
Semen analysis for male partners
While these tests provide insight into your fertility at the moment, they cannot predict the future. However, if an issue is detected now, you may choose to adjust your plans, freeze eggs, or seek treatment sooner—giving you more control over your fertility journey.
By staying informed and proactive, you can make empowered decisions about your reproductive health. If you resonate with any of these warning signs, don’t wait—seek an evaluation and take control of your fertility today.
