The incidence of infertility has been rising in recent years with the accelerated pace of life, increased work pressure, increased environmental pollution, changes in diet structure and changes in fertility concepts. Infertility is defined as the inability of a couple with a normal sexual life to conceive or maintain a pregnancy in the female partner after more than one year of cohabitation without using contraception. Infertility encompasses both pregnancy and childbirth, i.e., it includes the inability to conceive, the inability to carry a pregnancy to term, and/or the inability to have a live birth. Primary infertility in women is defined as never having been pregnant or never having given birth after sexual maturity, while secondary infertility is defined as having had a pregnancy in the past (including full-term pregnancy, preterm birth, miscarriage and ectopic pregnancy, gravida, etc.) and subsequent infertility. Primary infertility in men is defined as never having conceived or given birth to a woman, while secondary infertility is defined as having conceived a woman and subsequently developing infertility. It is common for infertile couples to have an arduous journey to find a child. The following is a description of the diagnostic process of infertility, with a view to making less of a detour for infertile couples. It is generally believed that female infertility accounts for about 40% of the causes, male infertility accounts for about 40%, and both factors account for about 20%. The main etiological factors are: ① ovulation disorders (mainly polycystic ovary syndrome PCOS, hyperprolactinemia or decreased ovarian reserve function); ② pelvic pathology (abnormal function of uterine oviducts to transport gametes or embryos for implantation, etc.); ③ male infertility (spermatogenic dysfunction); ④ immune factors; ⑤ unexplained infertility (a large part is related to the ageing of women to be pregnant) in 5 major categories. Because male fertility testing is convenient, non-invasive and inexpensive, the male partner’s semen is generally examined first for routine analysis: the indicators are tested according to the WHO 5th edition standards, and sperm with abnormal morphology are stained and analyzed. Those with abnormal results are then subjected to 2 to 3 re-examinations for confirmation. And in principle, female examinations range from simple to complex, from non-invasive to invasive, from economical to expensive. After the initial gynecological examination follow the following clinical pathway: Female ovulation monitoring: The best way to monitor ovulation is transvaginal ultrasonography, which is usually started on day 10 of the normal menstrual cycle. The follicles are 20-24 mm in diameter at the time of ovulation. The likelihood of pregnancy with follicles less than 17 mm in diameter is small. 5 days before ovulation, the dominant follicle grows 2-3 mm per day and grows rapidly within 24 hours of ovulation. After ovulation the follicles disappear and fluid appears in the pelvis. If ovulation is abnormal, monitor for 2 to 3 consecutive cycles. Endocrine examination: (1) Sex hormone six: blood is collected on day 2-3 of the menstrual cycle for examination. (1) Follicle stimulating hormone (FSH): FSH >20U/L indicates decreased ovarian reserve, seen in premature ovarian failure, ovarian insensitivity syndrome, primary amenorrhea, etc. (2) Luteinizing hormone (LH): FSH and LH are less than 5 U, suggesting hypothalamic pituitary hypofunction, which is seen in Silhan’s syndrome; FSH and LH are greater than 40 > U, suggesting ovarian failure; LH/FSHR2, suggesting PCOS. (3) Prolactin (PRL): PRL > 25 μg/ml is considered hyperprolactinemia, PRL is affected by various factors and should be measured repeatedly. High PRL can cause ovarian dysfunction, abnormal menstruation, breast milk and infertility in women. (4) Estradiol (E2): 48-52l pmol/L in preovulation, 370-1835 pmol/L in ovulation, 272-793 pmol/L in late ovulation. low values are seen in ovarian hypofunction, premature ovarian failure, and Silhan syndrome. (5) Progesterone (P): <4.8 nmol/L in the preovulatory phase and 7.6-97.6 nmol/L in the post-ovulatory phase. Low values of P in the post-ovulatory phase are associated with luteal insufficiency and ovulatory uterine dysfunctional bleeding. (6) Testosterone (T): normal is 0.7-2.1 nmol/L. Hyperandrogenemia can cause female infertility. (2) Other endocrine tests: screening for diseases such as thyroid function, adrenal gland disease, diabetes mellitus, etc. Examination of tubal function: It is the most important part of the infertility examination and is a prerequisite for choosing the correct treatment for infertility patients. It is usually performed 3-7 days after the patient's menstruation. (1) Tubal iodine contrast (HSG): 5ml of iodine oil is injected into the uterine cavity through a catheter under fluoroscopy. If no filling of the fallopian tubes is seen, wait for 3-5 minutes and then inject the contrast agent and take a film 24 hours later. The site of tubal obstruction can be known, and the morphology of the uterus and fallopian tubes can be understood. (2) Laparoscopy: If the tubal obstruction is caused by pelvic inflammatory disease, the tubal obstruction is purely intraluminal if the tubal appearance is normal; it can also be manifested as tubal inflammatory mass, tubal umbilical curl or adhesion with surrounding tissues; if there is tubal effusion, the tubal thickening, thin wall and fluid retention in the lumen. Pelvic tuberculosis presents as yellowish-white corn nodules on the peritoneum, caseous necrotic-like lesions, and calcified spots; endometriosis presents as small rice-sized blebs in the pelvis, small granulomas, or peritoneal defects. It is also important to note that tubal strictures and tubal convolutions can also cause infertility. Laparoscopic tubal lavage allows direct visualization of methylene blue flow from the umbilical end and tubal dilatation, which is more accurate than ultrasound tubal lavage. (3) Tuboscopy: It is possible to see directly whether there are anatomical changes in the whole fallopian tube and whether there are adhesions and damage to the mucosa, and biopsy and separation of adhesions can be performed, so that the diagnosis and treatment of tubal infertility can be significantly improved. (4) Hysteroscopy: The ultimate means to evaluate the uterine cavity and identify the associated lesions. Hysteroscopy can be done from 3 days after menstruation to the pre-ovulatory period. To clarify the etiology of infertility, such as uterine adhesions, endometrial polyps, submucosal fibroids, uterine longitudinal septum, etc. and restore the normal anatomical structure and function. ④Post-coital test: After intercourse near ovulation, the posterior fornix and cervical mucus are taken. The post-coital test is a test to detect the penetration of sperm into the cervical mucus and the acceptability of the cervical mucus to sperm (i.e. compatibility). ⑤ Immunological tests: e.g. anti-hyaline band antibodies, ovarian autoimmune antibodies, intra-serum antiphospholipid antibodies, cervical mucus sperm antibodies, endometrial antibodies. ⑥Blood karyotype examination: special indications are required, such as primary amenorrhea or abnormal genital development. If repeated miscarriages or output of malformed children, both spouses should be examined.