Infertility is a problem that affects many couples. Most adults have life plans that include children. When efforts to have children are unsuccessful, feelings of helplessness, frustration and despair are common. It is often at this point that many couples seek help from a Clinician. The Clinician's role is not only to help define the couple's problem, but also to be sympathetic and considerate to their emotional needs at this most difficult time. An understanding of the epidemiology, as well as of the historical aspects of the treatment of infertility, will be extremely helpful in achieving this goal.

Infertility is defined as the state in which a couple, desirous of a child, cannot conceive after 12 months of unprotected intercourse (Mueller and Daling, 1989; Thonneau et al., 1991). This is taken as being abnormal as 90% of couples will conceive within that time (Tietze, 1956; 1968). Infertility is either primary, when no pregnancy has ever occurred, or secondary, where there has been a pregnancy, regardless of the outcome (Thonneau et al., 1991). The ratio of patients presenting with primary and secondary infertility has remained remarkably stable with 67–71% of patients with infertility presenting with primary infertility and 29–33% presenting with secondary infertility (Hull et al., 1985; Templeton, Fraser and Thompson, 1991; Thonneau et al., 1991).

To understand infertility better, it is important to appreciate the epidemiological term, fecundity (Spira, 1986; Jansen, 1993).