The standard definition of infertility is the inability to conceive after 12 months of unprotected sexual intercourse. Today, this has been modified to take age into account, and now women over 35 may be considered infertile if they have failed to conceive after trying for six months.

Once a couple is diagnosed as infertile, the doctor will perform tests to determine the cause or causes. We can then begin treatment. Today's technology often allows even truly infertile couples to conceive a child.

There are three conditions that need to be met for conception to be possible: sperm must be present, the fallopian tubes must be open, and ovulation must be able to occur. If one or more of these conditions is compromised, the couple suffers from "true infertility." If all three conditions are met but the couple has failed to conceive, the diagnosis is "sub-fertility."

Initial evaluations are individually tailored to each patient and couple, but there are a few standard tests performed to evaluate these three critical factors. These include measurements of the hormones that regulate ovulation and egg quality, imaging tests of the fallopian tubes, ultrasound, and semen analysis (volume, sperm count, motility and morphology).

For about 10-20% of infertile couples, even with a thorough evaluation a cause for infertility cannot be determined. This is called "unexplained infertility" and may be caused by intermittent symptoms such as irregular ovulation or variable sperm count, or by other factors that we do not yet understand. Some couples with unexplained infertility successfully conceive after treatment or even without treatment.