A 33-year-old woman and her husband have had regular unprotected intercourse for 9 months without conception. Her cycles are ovulatory (confirmed by mid-luteal progesterone), his semen analysis is normal twice, and hysterosalpingography shows patent tubes. Both are asymptomatic. What is the MOST appropriate next step?
- A Continue expectant management with timed intercourse and reassess at 12 months ✓
- B Proceed directly to in vitro fertilization
- C Start empiric clomiphene citrate 50 mg days 2 to 6
- D Perform diagnostic laparoscopy with dye test
Correct answer: A. Continue expectant management with timed intercourse and reassess at 12 months
Explanation
Infertility is defined as failure to conceive after 12 months of regular unprotected intercourse in a woman under 35 years. With all basic investigations normal, monthly fecundity is around 20 to 25 percent and 80 to 90 percent of such couples conceive within one year, so expectant management is correct. Clomiphene offers no benefit in an already ovulating woman and IVF or laparoscopy expose her to cost and surgical risk without indication. Reassessment and escalation of treatment occur once the 12-month mark is reached.
Reference: Williams Gynecology, 4th ed.
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Written and medically reviewed by the StethoPrep medical team.