Introduction

There comes a time when a couple who have been trying unsuccessfully to start a family decide to seek medical attention. The timing of this decision varies; some may present to the clinician after just a few months of trying while others only do so after several years. There are no hard and fast rules about when to seek medical attention for infertility. On empirical grounds one can advise 12–18 months, knowing that it may take up to 12 months or so for the majority of couples to become pregnant naturally. Some clinicians may advocate a period of two years since spontaneous conceptions can and do still occur up till this time and even afterwards. However, such advice should take into consideration the individuals in question and factors such as the woman's age, the presence of symptoms suggesting an underlying cause for their infertility, whether the couple would wish to have infertility treatment at that time or whether they wish to wait for some more time before having any evaluation or treatment. For example, a 38-year-old female partner, in a couple who have been trying unsuccessfully for one year to have children, should be evaluated immediately because she does not have many more years remaining of optimal functioning of the ovaries.