Used to describe methods of planning based on observation of naturally occurring signs and symptoms of fertile phase of menstrual cycle. Your menstrual cycle lasts from 1st day of your period to the day before your next period starts. This is on an average 28days. Midcycle, an egg is released from one of your ovaries (ovulation). The egg only lives around 24hrs & a sperm must meet the egg within that period for pregnancy to happen. The male sperms have a lifespan of 3 to 7 days post ejaculation within the female reproductive tract. So, you can get pregnant in up to 7 days before you ovulate and up to 2 days after ovulation. Thus, by tracking your cycle, you can calculate when you're most likely to be fertile and plan intercourse during that period. While planning for pregnancy it is better to have intercourse alternate days during fertile period. Almost 80% of the couples will conceive within one year and 90% will conceive in 2 years. When to get evaluated by a doctor - 1. You have not become pregnant after 1year of having regular sexual intercourse without the use of birth control. 2. You are older than 35years of age & have not become pregnant after trying for 6 months without using birth control. 3. Your menstrual cycle is irregular. 4. You and/or your partner have any medical problems - Diabetes, Epilepsy Thyroid or prior surgeries 5. You and/or your problem have any problems during the act of sexual intercourse. 6. Family history of any genetic problems Initial Evaluation Evaluation includes examination & tests to try to find the reason why you & your partner have not become pregnant. In many cases, infertility can be successfully treated even if no cause is found in the preliminary tests. Basic treatments available - Natural cycle monitoring - In patients who have difficulties related to ovulation timings - patients can be monitored on ultrasound to determine when ovulation occurs and time intercourse accordingly under fertility specialist guidance. Ovulation Induction - This process involves stimulation of ovaries through the use of fertility drugs, tracking ovulation via ultrasound and giving dates for timed sexual intercourse. This is especially useful in cases where female partner has irregular cycles and hence may not be ovulating. Success rate is 5 -10% per cycle. Intrauterine Insemination (IUI) - Involves laboratory procedure to separate fast-moving sperm from sluggish or non-moving sperm & placing of washed sperms in women uterus when she is ovulating through a thin catheter. Mostly used in mild to moderate male factor infertility in conjugation with ovulation induction. Success rate is approx. 15-18 % per cycle. Minimally invasive surgery (laparoscopy or hysteroscopy) - Laparoscopy is a surgical procedure which involves insertion of a narrow telescope like camera through a small incision in the abdomen - allows visualization of abdominal & pelvic organs including uterus, fallopian tubes and ovaries. Hysteroscopy is inspection of uterine cavity that allows for diagnosis & treatment of various uterine conditions - some of which can lead to fertility problems. Invitro-fertilization (IVF) - Multiple Eggs are collected from your ovaries after stimulating with hormone injections & fertilized with partners sperm in the laboratory, where they develop into embryos in 2-5 days. The doctor then puts the embryos back into your uterus. Success rate is approx. 40-60 %. In case couple fails to conceive with above procedures they will be evaluated further and may need more advanced fertility procedures.