In the United States there are 6.2 million women with an impaired ability to reproduce, and approximately 10.2% of women ages 15-44 are infertile (6). Infertility is not considered a disease by most third party payers and medical diagnosis and treatment usually requires the couple to provide payment. Because infertility is not a life-threatening disease, choice of therapy often rests with the couple, which is frequently a choice of cost-consideration rather than cost-effectiveness. Couples frequently request therapy which is the least costly even though the efficacy may be low. The most important role of the physician in these cases is education and barring therapy whose risk-benefit ratio is too low for safety.

Thus, the evaluation and therapy of infertile couples is often dictated by the amount of funds available. This review, however, discusses the disease in an academic manner without emphasis on practicality. Studies available to evaluate the science rather than the art of medicine will be emphasized in order to provide readers with factual information, but this should not be interpreted as minimizing the practical and sensitive side so important in the clinical practice of medicine. Rather, armed with as much information as possible, each physician may be best able to tailor the evolution and therapy to the needs and resources of the individual.