Infertility can be defined as one year of unprotected intercourse without conception. It is estimated that about 90% of couples will achieve pregnancy in the first year and 95% in 2 years. One year is acceptable for younger nulligravida aged below 30 years but could be too long for women over 35 years as fertility diminished rapidly.

During the first investigation of the infertile couple for assisted conception, both husband and wife is encouraged to attend the primary consultation together and they are thoroughly investigated as a unit. They are required to supply any relevant information and test results that are in their possession. Series of questions on family background, medical history, menstrual history and exploration of any sexual problem will be asked during the primary consultation. A complete physical and pelvic examination of the female and genital examination of the male are integral part of the primary consultation.

Assessing the Causes:
The female partner is responsible for a couple's infertility in around 40% of cases and the male partner in a further 40%. Around 20% remain unexplained. Tests are required to determine a specific cause of infertility.

Evaluation and Treatment of the Infertile Man:
Male sub-fertility may be the largest single cause of human infertility, responsible for one third of all primary infertility, 20% of secondary infertility and for a further 20% of primary infertility involving both partners. Some of the intractable forms may be ultimately require donor insemination.

There are various factors that could cause male infertility, such as varicocele, hormonal deficiencies, blockage in the passage in epididymis, vas deferences or ejaculatory ducts, non blockage azoospermia, congenital absence of seminal vesicles, retrograde ejaculation and failure to ejaculate, and deficient or abnormal spermatozoa.

The initial infertility investigation for a man is semen analysis. When required, 2 specimens are usually organized within one month to minimize the chance of laboratory error and the possibility on an illness that might provide misleading indication of abnormal spermatogenesis.

Evaluation and Treatment of the Infertile Woman:
Infertility is aged-related, a fact not easily accepted by a previously fertile woman who presents with diminished reproductive function. The decline in human fertility with age has ramifications for treatment. Approximately 10% of women experience episodes of infertility in the early 20's.The figure climbs to another quarter or more in the early 40's. Causes of infertility may be include ovulatory dysfunction, impaired egg quality, disturbed endometrial receptivity, and a greater incidence of endometriosis with older age. One quarter of infertile couples have more than one cause of infertility.

The initial infertility investigation for the woman is to confirm ovulation by taking blood for hormonal evaluation and ultrasound scanning to investigate the patentee of reproduction organs.