A 34-year-old woman with unexplained infertility for 2 years has normal ovulation, patent tubes, and normal semen analysis. She undergoes controlled ovarian stimulation with gonadotropins plus intrauterine insemination (IUI). Which statement regarding gonadotropin-IUI versus expectant management in unexplained infertility is most accurate?

• A Gonadotropin-IUI significantly improves cumulative live birth rates compared with expectant management
• B Gonadotropin-IUI is less effective than clomiphene-IUI in unexplained infertility
• C Gonadotropin-IUI increases pregnancy rates per cycle but carries a significant risk of multiple pregnancy ✓
• D Expectant management for 6 months is less effective than gonadotropin-IUI in women aged 34 years

Explanation

Gonadotropin-IUI increases pregnancy rates per cycle compared with expectant management, but it carries a significantly higher risk of multiple pregnancy (10-20% twin rate) compared with clomiphene-IUI. Current evidence does not show a significant improvement in cumulative live birth rates over expectant management. For unexplained infertility in women under 35, expectant management or clomiphene-IUI are typically tried before gonadotropin-IUI due to the multiple pregnancy risk.

Reference: NICE Guideline on Fertility Problems, 2017 (updated 2023) ed.

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Written and medically reviewed by the StethoPrep medical team.