This article focuses on the diagnosis and treatment of the various causes of female infertility. The methods employed are based as far as possible on evidence related to outcome measured as time-specific or cycle-specific pregnancy rates and presented graphically. The diagnosis of male infertility and ovulation failure and induction are discussed in detail elsewhere in this issue. Male infertility is mentioned herein as it involves management of the couple and in a concluding section summarizing the basic investigation of a couple in specialist infertility practice and their choice of treatment.

Emotional problems and philosophical questions affect clinical practice and are of profound importance in the provision of services. They include damage to patients' self-esteem and sense of well-being, their grieving for children that never were, usually in secret, and frustrations owing to service limitations by budgetary constraints. The medical profession and society must decide whether everyone has a right to have a child and therefore access to treatment. The welfare of any offspring who may result from treatment should be of overriding concern. The risk to offspring caused by treatment should be minimized; the main risk in current practice is from multiple pregnancy. Treatments employing donor gametes involve specific emotional risks not only for the recipient parents and for their children but also for the donors, and counseling must be provided accordingly.

In clinical practice it is worth appreciating that patients' objectives are often quite different from those of physicians. The goal of physicians is to reach a diagnosis and administer treatments whose effectiveness can be measured in terms of pregnancy and live birth rates. In contrast, patients desire a baby and see themselves as sustaining emotional and interrelational problems requiring understanding, counseling, and education.