In vitro fertilization (IVF) and other assisted reproductive techniques are now fully accepted modalities of treatment for subfertility in our modern world. The indications for IVF have increased with the development of newer techniques such as ICSI, surgical sperm retrieval, embryo biopsy, and cryopreservation techniques, and IVF has become the cumulative step for the diagnosis and treatment for unexplained infertility. Certain indications for subfertility discussed in this chapter include tubal infertility, endometriosis, ovarian dysfunction, surrogacy, and male factor. The typical IVF cycle involves the following stages: stimulation for multiple follicular development, monitoring follicular growth and development, trigger of follicular maturation, oocyte recovery and identification, insemination/ICSI, embryo culture, embryo replacement, luteal phase support and confirmation of pregnancy. Traditionally, pregnancy rate per cycle has been used to compare results but gradually cumulative pregnancy outcome over the course of treatment may become more pertinent to the couple.

Female fertility begins to decline many years before menopause, despite continued regular ovulatory cycles. Decreased fecundity with increasing female age has long been recognized in demographic and epidemiological studies. Traditionally, the evaluation of the infertile female consists of: (i) ovulation assessment (ovulatory factors), (ii) evaluation of the uterine morphology (ovulation assessment) and tubal patency (tubal factors), (iii) assessment of the presence of pelvic pathology (by laparoscopy) (peritoneal factors), and (iv) postcoital test (cervical factors). Hysterosalpingography (HSG), laparoscopy are widely used in assessing infertility. Chlamydia antibody testing is a screening method for assessing tubal infertility. HSG, sonohysterography, hystero-salpingo contrast sonography (HyCoSy), magnetic resonance imaging (MRI) and hysteroscopy are used in assessment of uterine factors related to infertility. Currently, the best method to monitor ovulation is transvaginal ultrasound, which can be used to demonstrate the growth of a dominant follicle and provide presumptive evidence of ovulation and leutinization.