This chapter discusses the prevalence of infertility and the importance of the initial assessment of the infertile couple. Education of the public about the known decline in fertility that occurs with age, particularly in women older than 35 years, is important. The preliminary investigation centres on the need to demonstrate that the woman is ovulating. Semen analysis remains the most important means of assessment for male. In the fertility clinic setting, a pelvic ultrasound examination may be useful. Diagnostic categories in most studies include male factors, disorders of ovulation, tubal factors, endometriosis and uterine factors related to infertility, and unexplained infertility. Ovulatory disorders, often associated with irregular menstruation, are associated with reduced chances of natural conception. Ovulation induction provides good chances of success if there are no other complicating factors such as tubal compromise or severe impairment in sperm quality.

Women's causes of infertility include ovarian and tubal or mechanical factors. Cervical and uterine factors can include an abnormally shaped uterus (bifid, bicornuate, or anatomy changed by fibroids) or inimical cervical mucus. Both partners should be examined and cultured for sexually transmitted disease, especially chlamydia. Counseling the couple about the normal menstrual and ovulation cycle, about the effects of medications and alcohol on fertility, and about expectations on becoming pregnant is important. The effect of the infertility depends on the age of the couple, their personality and coping styles, pre-existing psychopathology, medical causes, and motivations for pregnancy. Five percent of children born to unmarried mothers during the 1990s were placed in adoption. The family physician can often make a positive impact on a couple's quest for fertility, using simple office-based diagnosis and treatment. The physician can help couples through fertility treatment and also through the problems and concerns of adoption.