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I am pleased to present the fifth edition of Infertility in Practice, which has been updated every 5 years or so since it was first published in 1997. Throughout this time, our understanding of infertility and its management has continued to expand rapidly. Infertility in Practice has been written as a practical guide and is based on my experience over the last 40 years of daily clinical practice. The aim of the book is to place the modern approach to the management of infertility in the context of sound theory and evidence-based therapy. I have striven to provide the reader with a comprehensive classification of the causes of infertility, their investigation and their management. In this edition, I have thoroughly revised and updated the text and completely rewritten most of the chapters. In vitro fertilisation (IVF) has been available for almost 45 years, and, in many European countries, 2–5% of babies are the result of IVF therapy. Indeed, approximately 10 million babies have been born worldwide from IVF, half in the last 10 years. A great deal of public attention has naturally been focused on the high-tech advances in assisted conception therapies, yet a fundamental issue is the preconception health of both partners, which is key both to conception, whether natural or assisted, and to the birth of a healthy baby. I introduced preconception health in the very first edition of this book at a time when few were addressing this important topic, and it remains just as relevant now – if not more so. In this edition, I bring in the latest thoughts on nutritional health, periconception care and the exciting new world of the microbiome. Since the fourth edition of Infertility in Practice was published, there have been many advances in the understanding and management of infertility and other updates to practice that are discussed in this new edition – for example, a greater understanding of the pathophysiology of ovarian ageing and ovarian reserve testing, classification of disorders of ovulation and the management of polycystic ovary syndrome, refinement of regimens for superovulation, improved embryo culture systems and the use of artificial intelligence for the selection of embryos, assessments for endometrial receptivity and management of recurrent implantation failure, and pre-implantation genetic testing (PGT) as a therapeutic tool, opening up the possibility for aneuploidy screening. The clinical approach to investigation and therapy also has made great strides to minimise the time taken to reach a diagnosis and direct a couple swiftly to the appropriate treatment. The field has also seen the publication of a number of evidence-based guidelines for the investigation and management of infertility, produced variously by the British Fertility Society, the Royal College of Obstetricians and Gynaecologists, the UK National Institute for Health and Care Excellence, the European Society for Human Reproduction and Embryology, the American Society for Reproductive Medicine and The World Health Organisation. It is reassuring to see a consolidation of knowledge in an attempt to ensure evidence-based practice which, in the United Kingdom, has been used to state the case for adequate funding of fertility care, although sadly with little effect on the decision makers in government. When one is determining appropriate treatment for the management of infertility, there may be one clear treatment or several potential options. Furthermore, there are often a variety of drugs to choose between and several potential treatment protocols. It is important to consider not only the efficacy of treatment but also its cost-effectiveness on the basis of a combination of scientific evidence and health economics. There has been a trend for cost-effectiveness analyses to be sponsored by the pharmaceutical industry. Although much research could not take place without industry support, it is important to be cautious when interpreting such data. The treatments for most causes of infertility provide very satisfactory cumulative chances of conception and of the birth of a healthy child. However, the side effects must be borne in mind, whether it is the immediate risk of ovarian hyperstimulation syndrome and multiple pregnancy or the long-term health risks, such as the possibility of ovarian cancer (reassuringly not the threat it was once thought to be). In this edition, I also discuss the outcome for children born as a result of assisted reproduction technology. Improvements in cryopreservation technologies now enable the successful freezing of oocytes, ovarian tissue and even testicular tissue and the prospect of preserving fertility before sterilisation therapy for cancer and other conditions. More controversial is the potential to freeze oocytes as an insurance policy for young women who wish to delay childbearing for social reasons.