If you have been trying to conceive without success, you are not alone and answers are closer than you think. Infertility affects 1 in 8 couples in the United States, yet many women wait years before seeking a proper evaluation. Understanding how OB-GYNs diagnose infertility is the first step toward getting the answers and care you deserve.
What Is Infertility?
Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse or 6 months if you are 35 or older. It is a medical condition, not a personal failure. According to the American Society for Reproductive Medicine (ASRM), a complete fertility evaluation identifies a probable cause in approximately 85–90% of couples, making early evaluation one of the most important steps you can take.
Step 1: Medical History & Physical Exam
Your OB-GYN begins with a thorough review of your menstrual cycle history, prior pregnancies, sexual health history, medications, and lifestyle factors such as weight, stress, and smoking. A pelvic exam checks for structural abnormalities. This conversation alone can uncover critical clues about what may be affecting your fertility.
Step 2: Hormone Blood Tests
Hormonal imbalances are among the most common causes of female infertility. Your doctor will likely order:
- FSH & LH — follicle-stimulating and luteinizing hormones that regulate ovulation
- AMH (Anti-Müllerian Hormone) — the most reliable marker of ovarian reserve. Research published in the Journal of Clinical Endocrinology & Metabolism confirms AMH is one of the strongest predictors of fertility treatment response.
- Estradiol & Progesterone — to assess ovulatory function
- TSH & Prolactin — thyroid dysfunction and elevated prolactin are often overlooked causes of irregular cycles and infertility
Step 3: Ovarian Reserve Testing & Ultrasound
A transvaginal ultrasound allows your OB-GYN to count antral follicles (AFC) — small follicles that indicate your egg supply. This painless imaging also detects fibroids, ovarian cysts, and signs of endometriosis or polycystic ovarian syndrome (PCOS), all of which are leading causes of female infertility.
Step 4: Hysterosalpingography (HSG)
An HSG is an X-ray procedure that evaluates whether your fallopian tubes are open and your uterine cavity is normal. Blocked fallopian tubes prevent sperm from reaching the egg and are a significant infertility factor. Studies show HSG has a diagnostic accuracy of over 85% for tubal obstruction.
Step 5: Additional Testing When Needed
- Laparoscopy — minimally invasive surgery to identify endometriosis or pelvic adhesions
- Endometrial biopsy — evaluates the health of the uterine lining
- Genetic testing — recommended in cases of recurrent pregnancy loss
Common Causes of Female Infertility
- Ovulatory disorders (including PCOS) — the most common cause, accounting for up to 40% of female infertility cases
- Blocked or damaged fallopian tubes — often caused by prior infection, endometriosis, or surgery
- Uterine abnormalities — fibroids, polyps, or structural issues affecting implantation
- Diminished ovarian reserve — fewer or lower-quality eggs, detected via AMH and AFC testing
- Unexplained infertility — diagnosed in approximately 10–15% of couples after a full evaluation
When Should You See an OB-GYN?
Do not wait until something feels seriously wrong. Seek an evaluation if:
- You are under 35 and have been trying to conceive for 12 months
- You are 35 or older and have been trying for 6 months
- You have irregular or absent periods
- You have a known condition such as PCOS, endometriosis, or fibroids
- You have experienced two or more miscarriages
Early evaluation leads to earlier answers and more options.
Schedule Your Women’s Health Appointment with IVANA MD
If you have questions about your fertility or are ready for an evaluation, our experienced women’s health team in Missouri City, TX is here for you.
Call: 346-585-4077
4220 Cartwright Road, Suite 201, Missouri City, Texas 77459
This blog is for educational purposes only and does not constitute medical advice. Always consult a qualified women’s health provider for evaluation and treatment.
