Female Infertility Specialist in Ocala, Florida

Female Infertility Assessment and Treatment at Florida Women’s Health

Female infertility can be a complex and emotionally challenging journey for many couples. Understanding the underlying causes, undergoing appropriate testing, and exploring treatment options are essential steps in navigating this process. This handout aims to give you an overview of female infertility, including its potential causes and diagnostic tests. It is important to note that infertility can be multifaceted and include male factors. We recommend that your partner’s fertility is also evaluated with a semen analysis by their provider and treated accordingly.


Female infertility refers to the inability of a woman to conceive or carry a pregnancy to term after a year of regular, unprotected intercourse if under the age of 35 and six months if over 35 years old. Various factors can contribute to female infertility, including:

  1. Ovulatory Disorders: Irregular or absent ovulation can make conception difficult. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, and premature ovarian insufficiency (POI) can disrupt ovulation.
  2. Tubal Factors: Blockages or damage to the fallopian tubes can prevent the sperm from reaching the egg or hinder the fertilized egg from reaching the uterus for implantation. Pelvic inflammatory disease (PID) from sexually transmitted infections (STIs), endometriosis, or previous surgeries may cause tubal damage.
  3. Uterine or Cervical Factors: Abnormalities in the uterus or cervix, such as fibroids, polyps, or cervical stenosis, can interfere with implantation or the passage of sperm.
  4. Age-related Factors: As women age, the quality and quantity of eggs decline, making conception more challenging. Advanced maternal age is associated with decreased fertility and an increased risk of miscarriage.
  5. Endocrine Disorders: Hormonal imbalances, such as those related to thyroid dysfunction or insulin resistance, can affect fertility.
  6. Other Factors: Lifestyle factors, such as excessive stress, obesity, smoking, and excessive alcohol consumption, can also impact fertility. Extreme stressors can alter the brain’s signaling for menstruation and ovulation, leading to infertility. An investigation of stressors including extreme diets or exercise, low BMI, chronic diseases, or significant psychological stressors may be performed.

Diagnostic Testing for Infertility

We will often recommend a series of diagnostic tests to determine the underlying cause of infertility and tailor treatment plans accordingly. These tests aim to assess various aspects of reproductive health, including ovulation, ovarian reserve, uterine and tubal anatomy, and hormonal balance. Note, Day 1 of the menstrual cycle is the first day of full flow, not spotting. Here are some commonly used diagnostic tests for female infertility, along with the recommended day to obtain them within the menstrual cycle:


  • A thorough menstrual, medical, and social history is the first step in attempting to identify the underlying cause of infertility.

Blood Tests:

  • Thyroid Function Tests: Thyroid function can impact ovulation and fertility. A simple lab blood test will help to rule out thyroid dysfunction.
  • Women with PCOS have elevated androgens so free testosterone may be tested at any point during the menstrual cycle to confirm the diagnosis.
  • Other Endocrine Tests: Depending on the clinical presentation, additional blood tests may be performed to evaluate other endocrine disorders, such as elevated prolactin, diabetes, or adrenal insufficiency.

Ovarian reserve

  • Women are born with a set number of eggs. As the woman ages, her ovarian reserve or immature follicles decreases. To assess ovarian reserve, we can order blood tests with Day 2-5 follicle stimulating hormone (FSH) or anti-Mullerian hormone (AMN/AMH) at any time in the cycle.
  • A Day 2-5 transvaginal ultrasound will help us assess the number of antral follicles to also help determine ovarian reserve. A very high number of antral follicles can suggest PCOS as a cause of infertility. A very low number before the age of 40 can be suggestive of premature ovarian insufficiency (POI).

Ovulation Testing:

  • Ovulation Predictor Kits (OPKs): Begin using home OPKs twice daily (mornings and evenings) around mid-cycle (approximately Day 10 in a 28-day cycle) to detect the surge in luteinizing hormone (LH) that precedes ovulation.
  • Hormone Assays:
    • Progesterone is secreted by the corpus luteum, or the remnant of the mature follicle after ovulation has occurred. Progesterone levels may be measured 7 days after ovulation (usually Day 21 in a 28-day cycle, positive OPK, or 7 days before the expected onset of the next period).

Transvaginal Ultrasound (TVUS):

  • The goal of a TVUS is to assess for structural causes of infertility including fibroids, polyps, abnormalities of the inner lining of the uterus called the endometrium, or cysts within fallopian tubes or ovaries.

Hysterosalpingography (HSG):

  • HSG is a radiologic procedure performed under fluoroscopy or ultrasound guidance to evaluate the uterine cavity and patency of the fallopian tubes at a radiology center. A contrast dye is injected into the uterus, and X-ray images are taken to visualize the shape of the uterus and any abnormalities, as well as the flow of dye through the fallopian tubes.
  • HSG is typically performed in the early follicular phase of the menstrual cycle, ideally between Days 5 and 12. This timing helps ensure that the procedure is not performed during a possible pregnancy and allows for optimal visualization of the uterine cavity and fallopian tubes.


  • Hysteroscopy is a minimally invasive procedure that involves inserting a thin, lighted scope (hysteroscope) through the cervix into the uterus to visualize the uterine cavity. It can be performed to evaluate and treat various uterine abnormalities, such as polyps, fibroids, adhesions (Asherman’s syndrome), or congenital anomalies.


  • Laparoscopy is a minimally invasive surgical procedure that involves inserting a thin, lighted scope (laparoscope) through a small incision in the abdomen to visualize the pelvic organs directly. It is performed under general anesthesia and allows for the assessment and treatment of conditions such as endometriosis, pelvic adhesions, and tubal abnormalities.

Treat Female Infertility at Florida Women’s Health

Discovering the cause of female infertility can be a long and emotional process, but Florida Women’s Health in Ocala, FL will be with you every step of the way. We will make it our goal to find the right solution for you and your growing family. To book an appointment, please call (352) 369-5999.