Infertility is defined as 12 months or more of unprotected intercourse without pregnancy. It is primary when there is no previous pregnancy. It is secondary when fertility problems occur in a couple that has conceived on their own and had a child in the past. A standard infertility evaluation is made with a series of test [1] which are reported in Table 8.1.

Female infertility after 35 years old increases with age. The most common causes are ovulation problem, followed by tubal problems (previous PID, previous tubal pregnancy). More uncommonly it may be related to abnormal function of the hypothalamic-hypophyseal axis, to adrenal dysfunction, to metabolic disease, and to multiple pelvic disorders which can involve the different compounds of the Muller duct and the secondary Mullerian system. Moreover, in some of these entities like in PCOD, different factors can be associated. In some cases, the cause of infertility is unexplained.

Etiological diagnosis of infertility is mainly based on clinical and biological findings. However, imaging modalities, particularly ultrasound, occupy an important place in the detection and characterization of a pathologic process of the pelvic organs. This modality is also particularly appropriate to evaluate the ovarian function. MR can provide additional informations in the evaluation of infertility.

Ovarian infertility is related to three different causes: ovulation disorders which may be related to ovarian or to hypothalamic and hypophyseal dysfunction or endocrine disorders, endometriosis in which the factors responsible for sterility are multiple, and periovarian adhesions. When ovarian infertility is suspected, the first step in the work-up is to evaluate the ovarian reserve.