• Inability to become pregnant.
• A range of emotional reactions by either or both members of the couple. In general, such reactions are greater among childless couples. Having at least one child tends to soften these painful emotions.

A complete history and physical examination of both partners is essential.

Tests may include:

• Semen analysis -- the specimen is collected after 2 to 3 days of complete abstinence to determine volume and viscosity of semen and sperm count, motility, swimming speed, and shape.
• Measuring basal body temperature -- taking the woman's temperature each morning before arising in an effort to note the 0.4 to 1.0 degree Fahrenheit temperature increase associated with ovulation.
• Monitoring cervical mucus changes throughout the menstrual cycle to note the wet, stretchy, and slippery mucus associated with the ovulatory phase.
• Postcoital testing (PCT) to evaluate sperm-cervical mucus interaction through analysis of cervical mucus collected 2 to 8 hours after the couple has intercourse.
• Measuring serum progesterone (a blood test).
• Biopsying the woman's uterine lining (endometrium).
• Biopsying the man's testicles (rarely done).
• Measuring the amount of luteinizing hormone in urine with home-use kits to predict ovulation and assist with timing of intercourse.
• Progestin challenge when the woman has sporadic or absent ovulation.
• Serum hormonal levels (blood tests) for either or both partners.
• Hysterosalpingography (HSG) -- an x-ray procedure done with contrast dye that looks at the route of sperm from the cervix through the uterus and fallopian tubes.
• Laparoscopy to allow direct visualization of the pelvic cavity.
• Pelvic exam for the woman to determine if there are cysts.