Almost 90% of couples conceive after a year of unprotected intercourse. Evaluation of infertility is indicated if the female partner is under 35 years of age and the couple has been trying to conceive for one year. Immediate evaluation and treatment of infertility is appropriate in cases of known problems that impact fertility such as irregular menstrual cycles, pelvic endometriosis, past history of pelvic infection or sexually transmitted disease, previous abdominal or pelvic surgery, or severe male factor infertility. Because fertility declines with advancing age of the female, evaluation of infertility is warranted for a couple when the female partner is older than 35 and has been trying to conceive for 6 months without success. In the subgroup of women older than 40 years of age, a more aggressive approach in evaluating and treating infertility is generally recommended because of the high likelihood for significant and rapid loss of ovarian reserve in this age group.