It is essential to assess the function of the pituitary gland and ovaries by measuring the levels of these hormones. A blood test in the early part of the cycle will be taken and the levels of FSH and LH measured. It is also possible, and indeed, appropriate for some older women to measure other hormones, in particular InhibinB and Anti-Mullerian Hormone. These will indicate "ovarian reserve", giving very specific information about the long term potential activity of the ovaries; whereas the other hormones indicate present levels of pituitary activity. A different blood test will be required to assess progesterone levels and this will be taken around seven days before the period is due. The progesterone test will enable us to assess whether ovulation is actually happening.

It is also possible that certain other glands in the body, such as the thyroid or adrenal glands, may affect someone's fertility. Under certain circumstances, other blood tests may be taken to examine the function of these glands.

When the egg is released from the ovary it travels down a tube called the Fallopian Tube. For conception to occur, this is where sperms which have swum from the vagina, through the uterus (womb), meet the egg and fertilisation takes place. The fertilised egg then travels to the uterus where it implants and a baby begins to grow.

However, some women have an abnormality of the neck of the womb, its cavity or the Fallopian Tubes, which stops pregnancy occurring. There are two main ways of assessing the situation with regard to the anatomy and function of the women's pelvic organs. There are hysterosalpinogram (HSG) and laparoscopy. To these procedures a third new technique called Hysterosalpingo Contrast Sonography (HyCoSy) has recently been added.

This is an x-ray examination by which a special dye is injected through the neck of the womb into its cavity, and then into the Fallopian Tubes. The progress of this dye can be observed on a special monitoring screen and pictures taken at desired stages throughout the test. The whole procedure should not last more than a few minutes. It is almost always painless and may be compared generally to the distress and discomfort, which some women may feel when they are having a cervical smear test taken.

It is now possible to perform a screening test of tubal function in the consulting room. This new technique involves an injection of a special substance which shows up on ultrasound scanning. The procedure, which takes approximately ten to fifteen minutes, requires neither x-rays, nor hospital admission, nor anaesthesia, and is minimally uncomfortable for the patient.

In this procedure, the patient has to be admitted to a hospital and undergoes a general anaesthetic. At this time, an instrument is passed through a small incision into the patient's abdominal cavity, and the structures seen can be assessed. It is possible to inject a dye through the neck of the womb and observe its passage through the cavity of the womb and tubes, as spill will be seen through the laparoscope.

The advantages of this technique are that ovaries may be seen, as well as the other pelvic structures, but as distinct from the previous procedure, the only record is the impression gained by the surgeon performing the test. This is in addition to the need to be admitted to hospital, and the requirement for a general anaesthetic.

The relationships between diagnoses made by HSG or laparoscopy are almost identical and recent research has shown that the same diagnosis was reached in 95% of cases.