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Ovulation Disorder :
The failure to ovulate is the most common cause of female infertility. Ovulation problem can be caused by excessive weight loss, stress, thyroid problem, hypothalamus , pituitary or adrenal gland problem and polycystic ovary syndrome. This may delay or prevent the ovaries from releasing an egg. Symptoms that might suggest a hormone abnormality include unexpected weight loss or gain, fatigue, excessive hair growth or loss, acne or ovarian cyst. Synchronized hormonal changes leading to the release of an egg from the ovary and the thickening of the endometrium (lining of the uterus] in preparation for the fertilized egg do not occur.

Endometriosis / Endometrioma :
This is a condition where the tissue that makes up the lining of the uterus (endometrium) grows outside the uterus. Pelvic pain and infertility are common in women. Endometriomas (Ovarian/chocolate Cyst) indicates advance stage of endometrioses with reduce fertility.

Premature Ovarian Failure [POF] :
POF is absence of mensturation and early depletion of ovarian follicles before age of 40 . Ovarian hypofunction may be caused by genetic factors such as chromosome abnormalities, or it may occur with certain autoimmune disorders that disrupt normal ovarian function. Chemotherapy and radiation therapy can also cause ovarian hypofunction . Fertility treatment, known as egg donation, is an option for women with premature ovarian failure.

Abnormality in shape or lining of uterus :
Uterine fibroid are benign tumour located on the outside surface or within the muscular wall of the uterus .They cause infertility by interfering with the contour of uterine cavity and also blocking the fallopian tube. It can also interfere with embryo implantation or fetal growth.

Asherman’s Syndrome :

It is a condition characterized by the presence adhesion or fibrosis within the uterine cavity. Depending on the degree of severity, Asherman syndrome may result in infertility, repeated miscarriages, pain from trapped blood and future obstetric complication.

Age :
Age is also a risk factor of infertility .The ability of ovaries to produce eggs decline with age and there is increase risk of miscarriage.

Cervical causes :

A small group of women may have a cervical condition in which the sperm cannot pass through the cervical canal. Whether due to abnormal mucus production or a prior cervical surgical procedure, this problem may be treated with intrauterine inseminations

Unexplained infertility :
In 20% of couples ,cause of infertility cannot be determined using the current method of investigation

Diagnosis :
Diagnosis of infertility begins with medical history ,physical examination and several specific test to evaluate the entire reproductive system. These may include

Lab Test
Hormonal test on Day 2 or 3 of cycle .
Thyroid function test.
Measurement of progesterone in the second half of cycle to confirm ovulation.

Ultrasound Scan
Ultrasound reveals shape and size of uterus and ovaries and gives information about uterine cavity and ovarian cyst .

Hysterosalpingography [HSG]
This is imaging study of uterus and fallopian tubes. A radio opaque dye is injected through cervix and an Xray is taken to rule out any abnormality of uterus and tubes. HSG is performed before ovulation so that the dye does not disrupt an egg or developing embryo.

Post Coital Test [PCT]
It is done on the day of ovulation ,a few hours after intercourse . A small amount of cervical mucous is examined under microscope to evaluate the interaction of cervical mucous with sperm.

Endometrial Biopsy
Is performed to check if endometrium can support implantation and growth of a fertilized egg.

Hysteroscopy
Is visulaziation of uterine cavity by a telescope which is passed through cervix into uterus. we can detect presence of endometriosis, polyps, fibroid, pelvic scar tissue and blockage at the ostia of fallopian tube .

Laparoscopy:
In this procedure, a laparoscope (a slender tube fitted with a fiberoptic camera) is inserted into the abdomen through a small incision near the belly button. The laparoscope enables the doctor to view the outside of the uterus, ovaries, and fallopian tubes to detect abnormal growths, as in endometriosis.

For more check Type of Infertility In females