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Over the last 25 years, progress in the field of assisted reproduction has paralleled that in ultrasonography. Normal fallopian tubes are not usually seen by ultrasound, though it is sometimes possible to visualize the fimbrial end within fluid in the pouch of Douglas. The ovaries are usually seen lateral to the uterus, in close relationship to the internal iliac vessels. They can be identified by their echogenic stroma and sonolucent follicles. A variety of ovarian reserve tests are used in routine clinical practice to assess a woman's ovarian performance prior to controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF). Transvaginal ultrasound-guided aspiration of ovarian follicles provides a safe and effective means of oocyte retrieval. Embryo transfer is a crucial step of IVF treatment. Ultrasound is a cornerstone of prevention and diagnosis of potential IVF complications such as ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies.