A 30-year-old woman undergoes diagnostic laparoscopy for unexplained infertility. Bilateral tubes are patent on chromotubation. The uterine cavity appears normal on hysteroscopy. Semen analysis is normal. She has been trying to conceive for 3 years. What is the most evidence-based next step?
- A Intrauterine insemination (IUI) with controlled ovarian stimulation for 3–6 cycles ✓
- B Empirical clomiphene citrate for 6 cycles
- C Proceed directly to in vitro fertilisation (IVF)
- D Empirical laparoscopic ovarian drilling
Correct answer: A. Intrauterine insemination (IUI) with controlled ovarian stimulation for 3–6 cycles
Explanation
Unexplained infertility with patent tubes, normal semen analysis, and normal uterine cavity after 3 years warrants active treatment. IUI with controlled ovarian stimulation is the evidence-based first-line active intervention per NICE and ESHRE guidelines, offering reasonable cumulative pregnancy rates before moving to IVF. Empirical clomiphene alone (without IUI) offers minimal benefit over expectant management in unexplained infertility. Ovarian drilling is for anovulatory PCOS. IVF is the next step after failed IUI cycles.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.