Is It Infertility–Or a Hormonal Imbalance You Can Fix?

For women over 35, “infertility” means just 6 months without success. But is it infertility or a hormone imbalance you can fix?

Whether you’re ready to start a family and actively trying to conceive (TTC) or considering pregnancy in your 20s, 30s, or 40s, having hard data around your reproductive health can help you make informed decisions along the way.

Up to 25% of female infertility causes are linked to ovulation disorders–many of which stem from underlying hormonal issues. Without comprehensive lab testing, it’s difficult to tell the difference.

Female Infertility by Age

Fertility in Your 20s
‍

Your 20s are often considered the most fertile years, but that doesn’t mean challenges can’t arise. Even at peak reproductive age, underlying hormonal imbalances can quietly interfere with your ability to conceive.

‍
Some signs that your hormones might be out of sync include:

• Irregular or missed periods
• Unexplained weight gain or loss
• Acne or other persistent skin issues
• Excess facial/body hair (linked to high androgens levels)
• Low sex drive
• Low energy levels

Fertility in Your 30s

By your early 30s, fertility remains strong. But around age 35, a woman’s ability to conceive significantly declines–month over month. 

In your 30s, several biological and hormonal changes begin, which can contribute to fertility problems. Many women can still conceive naturally. But, the gradual decline in ovarian reserve and an increased risk of hormonal imbalances make it essential to monitor your reproductive health closely.

These are some frequently overlooked contributors to infertility for women in their 30s. 

1. Declining Anti-Müllerian Hormone (AMH) Levels

Studies show that AMH levels naturally decline with age–reducing significantly in the mid-to-late 30s. Lower AMH levels indicate fewer available eggs, which may reduce the chances of conception.

2. Increased Risk of Anovulation

Anovulation is a condition where the ovaries do not release an egg during the menstrual cycle, making conception impossible during that time. It’s one of the most common causes of female infertility and can occur in women of all ages, though it’s especially prevalent in those with conditions like polycystic ovary syndrome (PCOS), thyroid disorders, or high levels of stress.

Ovulatory disorders contribute to 25% of infertility cases, with age-related hormonal shifts being a primary factor

3. Higher Chances of Thyroid Dysfunction

Women in their 30s are at higher risk of thyroid disorders. Studies show thyroid dysfunction is directly linked to ovulatory disorders, luteal phase defects, and implantation failure.

Fertility in Your 40s

While it’s true that fertility naturally declines in your 40s, many women still go on to conceive naturally and have healthy pregnancies. Every woman’s reproductive timeline is unique—but it’s helpful to be aware of the potential challenges that can arise during this decade, so you can make informed decisions and seek support when needed.

Common fertility concerns in your 40s may include:

• Lower AMH levels
• Higher FSH levels
• Higher risk of miscarriage
• Greater impact of metabolic health
• Higher risk of uterine fibroids or endometriosis

‍

Fertility Testing: Key Biomarkers

Fertility isn’t just about the ability to conceive—it’s a reflection of your overall hormonal health. Your hormones dictate everything from when you ovulate to the quality of your eggs, and even your success rate for pregnancy. Yet, many hormonal imbalances go undetected until conception becomes difficult. 

Proactively testing these key biomarkers can help you stay ahead of changes in your reproductive health.

1. Sex Hormones

Sex hormones play a vital role in fertility by regulating ovulation, egg quality, and menstrual cycle regularity. Here are the key biomarkers to keep an eye on:

Follicle Stimulating Hormone (FSH)

FSH evaluates ovarian health and pituitary function. It can help determine a diagnosis of PCOS, perimenopause, or menopause. As a type of protein hormone, FSH is responsible for stimulating the ovarian follicles that produce and release eggs during ovulation.

Luteinizing Hormone (LH)

LH levels give insight into sexual development and fertility. During the menstrual cycle, LH releases estrogen, which triggers the release of an egg from the ovary, known as ovulation. It can also help determine states of perimenopause and menopause.

Estradiol (E2)

For females, testing estradiol–one form of estrogen–is key in detecting menopause, PCOS, androgen- or estrogen-producing tumors, uterine and breast cancer, and mitigating the risk of osteoporosis and cardiovascular disease. E2 prepares your uterine lining for embryo implantation (when a fertilized egg attaches to the lining of the uterus) and low levels can signal poor egg quality or weak ovulation.

Sex Hormone Binding Globulin (SHBG)

When SHBG levels change, it can impact the amount of available hormones in the body, either too much or too little. This can affect your menstrual cycle, as well as fertility. SHBG patrols the amount of sex hormones the body tissues can use, regulating estrogen and testosterone levels by binding to excess hormones in the blood. Low SHBG can contribute to hormonal imbalances seen in PCOS, which can directly affect infertility.

Anti-Müllerian Hormone (AMH)

AMH is a key fertility marker that assesses ovarian reserve (egg count) at the time of testing. This biomarker sheds light on your body’s potential to produce eggs for fertilization, particularly if one is nearing menopause or experiencing a hormonal condition such as PCOS or primary ovarian insufficiency (POI). Lower levels of AMH suggest fewer eggs and a decline in fertility potential.

Testosterone (Free & Total)

Often associated with men, testosterone also plays a key role in female fertility. It helps evaluate not only your fertility, but overall sexual function, muscle mass, energy, mood, insulin resistance/sensitivity, and pituitary function. Testosterone can also help diagnose and manage conditions like prediabetes, PCOS, or menopause. High levels–commonly seen in PCOS–can disrupt ovulation and menstrual cycles.

Prolactin 

Regulating your menstrual cycles and ovulation, elevated prolactin levels can suppress FSH and estrogen, causing irregular or skipped periods. It can also guide the diagnosis of infertility, menopausal symptoms, and/or estrogen and testosterone deficiency.

2. Thyroid Hormones

Many women don’t realize they have a thyroid issue until they face fertility challenges. Monitoring these key markers provides early insights and can help prevent fertility-related challenges.

Thyroid hormones impact your ovulation, menstrual cycle, and pregnancy outcomes. Even mild thyroid imbalances can disrupt hormone signaling. What that means for you? Conception can be harder, and miscarriages or pregnancy complications are a greater risk.

Thyroid Stimulating Hormone (TSH)

About 1 in 8 women have hypothyroidism, and a TSH test can help reveal thyroid issues. Produced by the pituitary gland, TSH controls the release of thyroid hormones triiodothyronine (T3) and thyroxine (T4). Thyroid issues can lead to irregular ovulation and increased miscarriage risk.

Triiodothyronine (T3) Free

T3 is the most powerful thyroid hormone in the body. It helps regulate body temperature, control heart rate, lower cholesterol, improve memory, promote regrowth after hair loss, soothe muscle aches, regulate bowel movements–and support fertility.

Thyroxine (T4) Free

This lab test is typically cross-referenced with TSH and T3 to gain insight into overall thyroid function. Along with T3, Thyroxine works to regulate metabolism and egg development–as well as heart and digestive function, metabolism, brain development, bone health, and muscle control. Low levels are linked to anovulation and early pregnancy loss.

Thyroid Antibodies (TPO & TgAb, TRAb)

Thyroid Peroxidase Antibodies (TPO) and Thyroglobulin Antibodies (TgAb) are used to assess the thyroid-related autoimmune disorder, Hashimoto’s and TRAb measurements are considered the gold standard for diagnosing Graves’ disease. Disorders like these can lead to infertility and increased risk of miscarriage. Maintaining optimal levels of these hormones may be associated with improved implantation rates and pregnancy outcomes.

3. Nutrients

Optimal fertility isn’t just about hormones—your nutrient status matters, too. And while you can prioritize eating fertility-boosting foods rich in antioxidants, healthy fats, complex carbs, and quality protein sources, it’s still possible for nutrient deficiencies to exist.

Monitoring these nutrient levels helps to identify and correct any deficiencies that could otherwise complicate your road to conception.

Vitamin D

Vitamin D enhances ovulation by altering anti-Müllerian hormone (AMH) signaling, increasing follicle-stimulating hormone (FSH) sensitivity, and boosting progesterone production. These processes are essential for egg development and release during your menstrual cycle.

Ferritin

Ferritin is a protein that stores iron in cells and releases it when the body needs to produce red blood cells. For women trying to conceive, maintaining healthy ferritin levels is important, as low iron stores may contribute to anovulation and an increased risk of miscarriage.

Iron

Healthy iron levels support vitality throughout the body by aiding oxygen transport, energy production, and immune function. Iron plays a key role in focus, metabolism, and overall well-being. Deficiency can lead to various health issues, including anemia, fatigue, weakened immune response, and even infertility by disrupting ovulation and menstrual cycles.

Magnesium

Magnesium is a mineral needed for your cells to make energy, for chemical pumps to work and stabilize membranes, and to help muscles relax. Magnesium is essential for female fertility, playing a key role in maintaining hormonal balance, supporting ovulation, and promoting overall reproductive well-being.

Homocysteine

Elevated homocysteine levels have been linked to fertility challenges in women, including poor egg quality and unexplained subfertility (reduced ability to conceive). These high levels are often tied to deficiencies in key nutrients like folate, vitamin B6, and vitamin B12. Testing homocysteine can help identify these hidden imbalances, allowing for targeted nutritional support that may improve reproductive outcomes.

Zinc 

Zinc is mostly known for its immune support, but it's actually a powerful mineral across all bodily systems. If deficient, it can impact your mood, sexual function, and immunity–amongst other things. Zinc is essential for egg development and maintaining a regular menstrual period.

4. Stress Hormones

Stress isn’t just a mental or emotional experience—it has profound effects on hormonal balance and reproductive health. Chronic stress can suppress ovulation, reduce progesterone levels, and impact egg quality.

The body prioritizes survival over reproduction, so when stress hormones remain elevated, fertility can take a hit. High stress can disrupt the hypothalamic-pituitary-ovarian (HPO) axis, leading to irregular cycles, anovulation, or implantation failure.

Cortisol 

Often referred to as “the stress hormone,” cortisol goes beyond stress to help the body with numerous functions. Chronic stress, however, is linked to ovulation disruptions.

Dehydroepiandrosterone sulfate (DHEA-S)

A precursor hormone that supports egg quality and ovarian function, DHEA Sulfate is the most abundant steroid hormone in the human body. It’s associated with longevity, positive reproductive outcomes, and immune system regulation. This test can gauge reproductive function and the health of your adrenal gland.

How Often Should You Test?

For women trying to conceive, testing every 3-6 months is recommended to:

• Track ovulation patterns
• Monitor ovarian reserve changes
• Address nutrient deficiencies
• Identify thyroid dysfunction early

Takeaway

Fertility is complex with many influences. Whether in your 20s, 30s, or 40s, hormone testing is an unlock for optimizing your chances of conception. Identifying imbalances early can save months of trial and error when trying to conceive.

Whether you’re just starting to think about your TTC fertility or facing challenges at present, use real data to inform a personalized, proactive approach to reproductive health.