A couple has unexplained infertility for 2 years. The woman is 34 years old. Post-coital test is satisfactory, HSG and laparoscopy are normal, and semen analysis is normal. The most appropriate next management step is:

• A Expectant management for another 1 year
• B In vitro fertilization
• C Intrauterine insemination with controlled ovarian stimulation ✓
• D Empirical clomiphene therapy for 6 cycles

Explanation

For unexplained infertility in a woman aged 34 after 2 years of trying, controlled ovarian stimulation combined with intrauterine insemination (IUI) is the recommended first active treatment, typically for 3–6 cycles. IVF is offered after failed IUI cycles or in older women with diminishing ovarian reserve. Empirical clomiphene alone without IUI has limited evidence in unexplained infertility with ovulatory women.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.