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Infertility is considered unexplained in couples who have normal semen analyses, evidence of cyclic ovulation, and a patent female outflow genital tract. But just how should such couples be treated? U.K. investigators randomized 580 couples with unexplained infertility of at least 2 years’ duration to expectant management, low-dose oral clomiphene citrate to ensure normal ovulation, or unstimulated intrauterine insemination to bypass any cervical barrier for 6 months. The women’s average age was 32.
The live birth rate was 17% with expectant management, 14% with clomiphene, and 23% with intrauterine insemination. After adjustment for confounders, no statistically significant differences were observed among groups. Women who were treated for …