In a patient with unexplained infertility, the FASTT trial compared clomiphene-IUI, FSH-IUI, and immediate IVF. What was the primary conclusion for treatment sequencing?

• A Accelerated treatment moving directly to IVF after 3 cycles of clomiphene-IUI was more cost-effective than conventional step-up ✓
• B Clomiphene-IUI should always precede FSH-IUI for at least 3 cycles before IVF
• C FSH-IUI produced the highest per-cycle live birth rates and should be first-line
• D All three strategies had equal cumulative live birth rates regardless of sequencing

Explanation

The FASTT trial (Reindollar et al., Fertility & Sterility 2010) randomized unexplained infertility patients to conventional (3 clomiphene-IUI + 3 FSH-IUI then IVF) vs accelerated (3 clomiphene-IUI then IVF, skipping FSH-IUI). The accelerated protocol achieved similar pregnancy rates in significantly less time and was more cost-effective because FSH-IUI did not add substantial benefit over clomiphene-IUI but added cost and time. This supported moving directly to IVF after clomiphene-IUI failure rather than an FSH-IUI intermediate step.

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

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