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Anovulation, a common cause of infertility, is often treated by inducing ovulation with clomiphene. For women who do not conceive after six clomiphene-induced ovulatory cycles, subsequent treatment options include continuing clomiphene, switching to letrozole or gonadotropins, adding intrauterine insemination (IUI), or initiating in vitro fertilization. To evaluate the utility of clomiphene, gonadotropins, and IUI, Dutch researchers randomized 666 women with anovulatory infertility (mean age, 30) who had not conceived after six ovulatory cycles of clomiphene to 1 of 4 groups: Gonadotropins with IUI or with intercourse only, or continued clomiphene with IUI or with intercourse only.
After a mean of three to four treatment cycles, live birth r…