IUI is a better alternative than IVF as the first-line treatment of unexplained infertility.

The treatment of a condition with no known cause, such as unexplained infertility is, unsurprisingly, controversial. The alternatives that have been suggested for the first-line treatment are expectant management, ovarian stimulation, intrauterine insemination (IUI) with or without ovarian stimulation, or IVF. As far as live births are concerned, the choice has realistically been narrowed down to IUI with ovarian stimulation by low-dose gonadotrophins using strict cancellation criteria versus IVF. In several well-designed studies, three cycles of the former have proved as successful as one cycle of IVF. As IUI is less invasive, more comfortable for the patient, markedly less expensive and safe with a high compliance rate, it should be recommended for the first-line treatment of unexplained infertility for couples in whom the woman's age is not more than 38 years.