The Silent Struggle: Understanding the Top 5 Causes of Female Infertility

Female infertility is a deeply personal and often silent struggle that affects more than 186 million individuals worldwide[1]. Approximately 15% of couples in Malaysia and 12% of couples in Singapore experience infertility[2]. While there are many factors that can contribute to infertility, it is crucial to gain a comprehensive understanding of the primary causes that hinder a woman’s ability to conceive. 


In this blog, we will delve into the top five causes of female infertility, shedding light on these issues to help women and their partners better comprehend this challenging journey.

1. Polycystic Ovary Syndrome (PCOS)

PCOS affects 6% to 12% of women of reproductive age[3]. PCOS can make it difficult for women to conceive because of three main factors:


  • Increased levels of a hormone called androgen, which can interfere with the development of eggs in the ovaries and cause symptoms like acne, thinning hair, and excessive body hair
  • Irregular ovulation and periods, making it hard to predict the fertile window
  • Enlarged ovaries with fluid-filled sacs surrounding the eggs, which can prevent their release. It’s important to note that not all women with PCOS have these enlarged ovaries


While PCOS can’t be cured, its symptoms can be managed with medical help, and a successful pregnancy is still possible.

2. Endometriosis

Endometriosis is a disease that affects over 10% of women and girls worldwide[4]. It involves the growth of tissue similar to the lining of the uterus outside of the uterus itself[5]. This abnormal tissue growth can lead to various complications, particularly in regards to fertility. In addition, women with endometriosis are more likely to experience endocrine and ovulatory disorders, further contributing to their fertility challenges[6].


Typical symptoms of endometriosis include pelvic pain (felt in the lower abdomen or back), severe menstrual pain, pain during or after sex, and digestive problems, but not all women with endometriosis are symptomatic[7].


While endometriosis can lower your odds of getting pregnant, it is still possible to conceive naturally, or you could boost your chances with fertility treatments[8].

3. Poor Egg Quality

About one-third of women over the age of 35 experience fertility issues[9]. This is often attributed to poor egg quality, which is a result of diminishing egg reserves. As women age, their egg reserves naturally decrease, leading to a decline in egg quality.


At the age of 37, women typically have approximately 27,000 eggs left, compared to the 400,000 eggs they had during mid-puberty[10]. This natural decline in egg quantity and quality is a normal occurrence as women get older and can impact their ability to conceive.


While it’s not possible to reverse the ageing process or increase the number of eggs in the ovaries, women can take steps to maintain their reproductive health. Practicing healthy eating habits, engaging in regular exercise, and maintaining a healthy lifestyle can have a positive impact on overall fertility.

4. Premature Menopause (Primary Ovarian Insufficiency)

Primary ovarian insufficiency, also known as premature menopause, is a disorder in which the ovaries cease to function before the age of 40[11]. This condition affects approximately 1 out of every 1,000 women aged 15 to 29 and 1 out of every 100 women aged 30 to 39[12].

For women over 35, perimenopausal symptoms include shorter and more irregular menstrual cycles, hot flashes, vaginal dryness, an increased urge to urinate and joint or muscle aches.

By freezing eggs at a younger age when they are still of good quality, you may increase the chances of a successful pregnancy if you decide to undergo IVF in the future[13]. Seeking expert guidance can help navigate these options and understand the best approach for individual circumstances.

5. Blocked Fallopian Tubes

Tubal factor infertility refers to the condition where there is an obstruction in one or both fallopian tubes, preventing the egg from traveling down the tube and into the uterus. This condition can affect up to 29% of women experiencing infertility issues[14].


One of the challenges with tubal factor infertility is that it often does not cause noticeable symptoms, which can come as an unwelcome surprise for women facing fertility problems. However, in cases of a specific type of blocked fallopian tube called hydrosalpinx, there may be signs of fluid accumulation in the blocked fallopian tube.


Several factors can lead to fallopian tube blockage. The most common cause is pelvic inflammatory disease (PID)[15], which is an infection that can result from certain sexually transmitted diseases (STDs) or bacterial infections. Other contributing factors may include current or past STDs, endometriosis (a condition where uterine tissue grows outside the uterus), complications from abortion or miscarriage, or any incidents in a woman’s medical history that may have caused scarring in the fallopian tubes[16].


Fortunately, tubal factor infertility is usually treatable. If one or both fallopian tubes are blocked and a woman still desires to conceive, she can discuss the next steps and potential treatment options with her treating doctor.


Understanding and listening to your body is a crucial step in your journey to getting pregnant, so you can start by checking your fertility status.


If you have any fertility-related questions or concerns, it’s essential to consult with your healthcare provider or a fertility specialist for personalized guidance and support. They can provide you with accurate information and recommend appropriate fertility treatments based on your individual needs.


[1] World Health Organization. (2021). Infertility. Retrieved from

[12 Dashti, S., Abdul latiff, L., Abdul Hamid, H., Mohamad Saini, S., Shah Abu Bakar, A., Binti Sabri, N. A. I., Ismail, M., & Jafarzadeh Esfehani, A. (2019). Prevalence of Polycystic Ovary Syndrome among Malaysian Female University Staff. Journal of Midwifery and Reproductive Health, 7(1), 1567-1575. doi: 10.22038/jmrh.2018.30370.1329

[3] Teede, H., Misso, M., Tassone, E., et al. (2020). Anti-Müllerian hormone in PCOS: A review informing international guidelines. Trends in Endocrinology and Metabolism, 31(7), 531-541.

[4] World Health Organization. (2023). Endometriosis. Retrieved from

[5] Zondervan, K.T., Becker, C.M., Missmer, S.A. (2020) Endometriosis. New England Journal of Medicine, 382, 1244-56.

[6] Practice Committee of the American Society for Reproductive Medicine. (2004). Endometriosis and infertility. Fertility and sterility, 82, 40-45.

[7] Bulletti, C., Coccia, M. E., Battistoni, S., & Borini, A. (2010). Endometriosis and infertility. Journal of assisted reproduction and genetics, 27(8), 441–447.

[8]  Macer, M. L., & Taylor, H. S. (2012). Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstetrics and Gynecology Clinics, 39(4), 535-549.

[9] Pregnancy tests | Office on Women’s Health. (n.d.). Office on Women’s Health.

[10] Committee Opinion No. 589. (2014). Obstetrics & Gynecology, 123(3), 719–721.

[11] Early or premature menopause | Office on Women’s Health. (n.d.). Office on Women’s Health.


[13] Ameratunga, D., Weston, G., Osianlis, T., Catt, J., & Vollenhoven, B. (2009). In vitro fertilisation (IVF) with donor eggs in post-menopausal women: are there differences in pregnancy outcomes in women with premature ovarian failure (POF) compared with women with physiological age-related menopause? Journal of Assisted Reproduction and Genetics, 26(9–10), 511–514.

[14] Al Subhi, T., Al Jashnmi, R. N., Al Khaduri, M., & Gowri, V. (2013). Prevalence of tubal obstruction in the hysterosalpingogram of women with primary and secondary infertility. Journal of reproduction & infertility, 14(4), 214–216.

[15]  Dun, E. C., & Nezhat, C. H. (2012). Tubal factor infertility: diagnosis and management in the era of assisted reproductive technology. Obstetrics and Gynecology Clinics, 39(4), 551-566.

[16] Briceag, I., Costache, A., Purcarea, V. L., Cergan, R., Dumitru, M., Sajin, M., & Ispas, A. T. (2015). Current management of tubal infertility: from hysterosalpingography to ultrasonography and surgery. Journal of medicine and life, 8(2), 157.


SG-NONF-00286 | 15 September 2023

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