The subfertile couple

Infertility is a common condition affecting around one in seven couples. In most cases, there is relative subfertility rather than absolute infertility. Couples should be treated together, and investigations should normally be performed after 1 year of unprotected intercourse. However, earlier evaluation may be indicated in the presence of risk factors. Initial investigations should follow a systematic and logical approach to evaluate ovulatory status, tubal function and semen quality. The simplest, least invasive and most productive tests should be performed first. Management will depend upon the cause, but the couple must be fully informed and involved in the decision-making process. The distress caused by the inability to conceive should not be underestimated, and a sympathetic, supportive approach is required at all stages of treatment. The aim of this article is to present an overview of the investigation and management of the infertile couple.