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Ovulation problems make up for most cases of infertility in women. When there is no ovulation, then there are no eggs that can be released from the ovaries into the fallopian tubes, therefore, fertilization cannot occur. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods. Sometimes, ovulation can occur but the quality of the eggs (oocytes) may not be sufficient for fertilization. This is especially true during premenopausal (the stage right before entering menopause) stage.

Less common causes of fertility problems in women include:
– blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for a previous ectopic pregnancy
– physical problems with the uterus, cervical weakness and adhesion in the uterus.
– uterine fibroids, polyps and free fluids.

Many things can affect a woman’s ability to have a baby and therefore contribute to problems of infertility. These include:
– Age. With age, ovarian reserves and egg quality tend to diminish. This decline becomes highly pronounced especially after 35 years of age. 
– Stress factors
– Poor diet that results in inadequate receipt of the essential nutrients
– Athletic training
– Being overweight or underweight
– Excessive tobacco consumption
– Excessive alcohol consumption
– Sexually transmitted and infectious diseases
– Any factor that contributes to hormonal imbalances.

Aging decreases a woman’s chances of having a baby in the following ways:
– The ability of a woman’s ovaries to release eggs ready for fertilization declines with age.
– The health of a woman’s eggs declines with age. With advanced ages, more genetic problems are observed due to aging of the eggs. 
– As a woman ages she is more likely to have health problems that can interfere with fertility.
– As a women ages, her risk of having a miscarriage increases.

How long should women try to get pregnant before calling their doctors?
Most healthy women under the age of 30 shouldn’t worry about infertility unless they’ve been trying to get pregnant for at least a year. At this point, women should talk to their doctors about a fertility evaluation. In some cases, women should talk to their doctors sooner. Women in their 30s who’ve been trying to get pregnant for six months should speak to their doctors as soon as possible. A woman’s chances of having a baby decrease rapidly every year after the age of 30. So getting a complete and timely fertility evaluation is especially important.

Where to begin?
The first step in infertility testing and assessment starts at your gynecologist’s office. A baseline ultrasound scan (sonogram) will be useful for antral follicle tracking (to see how many potential eggs each ovary contains). This should be done on day 2 or day 3 of your menstrual period. Similarly, on this very same day, you should ask for hormone testing in order to make an assessment of your ovarian function including FSH, LH, Estradiol, Prolactin, TSH and AMH. Based on these test results, we will be able to make an assessment and decide on the most appropriate course of action. For more information about preliminary testing and how to get started, please visit “Infertility Testing” section.