Usually investigation for infertility is carried out by gynecologists, because if a couple failed to conceive it has been traditionally expected that the woman has a problem and should visit a doctor. The general examination starts when the patient comes into the consulting room from observations of body habitus, skin, hair excess, gait and posture. Ultrasonography is a more accurate method compared with bimanual examination so more precise data about ovaries and uterus may be obtained with a transvaginal ultrasound probe than with palpation. The assessment of ovulation involves history, examination and investigation. At hysterosalpingography (HSG) radio-opaque dye is injected through the small canula via the cervix into the uterine cavity under X-ray screening. In patients with infertility, diagnostic hysteroscopy is usually combined with laparoscopy. X-chromosome abnormalities may affect fertility in women with Turner syndrome, especially in mosaic form.

Unexplained infertility is a diagnosis made by exclusion after a complete infertility evaluation. Standard testing for infertility should include semen analysis (evaluated according to the WHO criteria), assessment of ovulation (serum progesterone determination in the midluteal phase), and an evaluation of tubal patency. At present, other additional investigations contribute relatively little to effective diagnosis of unexplained infertility. Laparoscopy is required to make a diagnosis of endometriosis or adnexal adhesions, but in the presence of tubal patency, these lesions seem to be of lesser significance. The use of intrauterine insemination (IUI) together with ovulation induction in normally ovulating women carries a risk of ovarian hyperstimulation syndrome and multiple pregnancy. Based on the available information, it is reasonable to recommend an escalating course of gonadotropin ovarian stimulation with IUI and then in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

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.