EDITORIAL COMMENT: In this paper the authors have made an important point. Counselling concerning simple treatment options should be the first step in the management of infertility as for most other medical problems. Conversely it could be said, as stated by an Anglican priest to the editor about 10 years ago, that counselling the infertile couple, who were candidates for only the most complicated regimens of reproductive technology, should include acceptance of their infertility. Many years ago the editor, when doing a locum, met a couple whose longstanding infertility was the result of misunderstanding of the physiology of conception, with avoidance of coitus at the fertile time of the cycle - conception occurred 2 months after a simple explanation of the physiology of the menstrual cycle as advocated in this paper.

Summary: Eighty women attending for consultation at a tertiary referral fertility unit over a 3-month period were surveyed for their knowledge of fertility awareness and how they used this information to enhance their chances of conception. It was hypothesized that less than 50% of the subjects had an adequate understanding of when the fertile time occurred in their menstrual cycle. A questionnaire was completed anonymously by each subject and these were scored in 3 categories for fertility awareness by 2 independent Natural Family Planning teachers. Scores ranged from 0 for women who had no concept of fertility awareness, to 6 for women who were highly aware. The results showed that 26% (n=21) of subjects had a score of 4 or greater which was considered as having an adequate understanding. The hypothesis was accepted, giving reason for concern about the effectiveness of consumer education at all levels of fertility investigation.