Reflections on the way to conduct an investigation of subfertility

Infertility is a worldwide issue in reproductive health. In view of the World Health Organization's definition of health, the psychological and social consequences of infertility simply cannot be ignored. Prevention of infertility is difficult and does not help the couple seeking medical advice for infertility, whereas efficient treatment for infertility is time consuming, expensive and often unsuccessful. This article reflects on a shortened, yet full investigation of both partners' fertility before any treatment whatsoever, which is indispensable once the decision to help the couple medically has been made. By optimizing the use of modern gynaecological endoscopy within the woman's cycle, an exhaustive infertility investigation can be conducted within the span of two couple-physician contacts, thereby responding to the couple's concern, avoiding loss of time and energy due to inappropriate therapies, and directing the subfertility treatment correctly from the start. Trained gynaecologists can easily conduct this investigation in fertility centres in developed countries, as well as in centres for family planning in developing countries. The investigation can be employed either with an emphasis on diagnosis alone (and then even under local anaesthesia) or, if the necessary infrastructure is available, in combination with operative endoscopy under general anaesthesia where indicated.