A 31-year-old woman with unexplained infertility undergoes controlled ovarian stimulation with gonadotropins for IUI. On the day of hCG trigger, she has 4 dominant follicles (≥17 mm) and estradiol of 1800 pg/mL. What is the most appropriate management?

• A Proceed with IUI as planned
• B Administer hCG and proceed with timed intercourse only
• C Convert to IVF
• D Cancel the cycle and advise abstinence or barrier contraception ✓

Explanation

When 4 or more dominant follicles (≥17 mm) develop during gonadotropin-stimulated IUI cycles, the risk of high-order multiple pregnancy is unacceptably high. The cycle should be cancelled, and the couple advised to use barrier contraception or abstain. Converting to IVF is not standard practice in this scenario. Proceeding with IUI or timed intercourse risks multiple pregnancy.

Reference: Speroff's Clinical Gynecologic Endocrinology and Infertility, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.