First, we have to put things in perspective. The monthly pregnancy rate in the fertile population is only about 20%. The monthly pregnancy rate with unexplained infertility is 2% to 3%. Treatment with artificial intrauterine insemination (IUI) alone is of little benefit. Combining IUI with an oral fertility drug, such as Clomid® (clomiphene) or Femara® (letrozole) yields about a 10% pregnancy rate per cycle. This is typically tried for up to six cycles, at which time we may continue the IUIs, substituting the more potent injectable fertility drugs for pregnancy rates of up to 20% per treatment cycle, ie, back to the normal baseline rate. This is usually tried up to three cycles before moving on to IVF.

Answered by Jeffrey Goldberg, MD. Dr. Goldberg is board certified in obstetrics and gynecology and subspecialty board certified in reproductive endocrinology by the American Board of Obstetrics and Gynecology. He is head of the Section of Reproductive Endocrinology and Infertility at Cleveland Clinic and the director of the Reproductive Endocrinology and Infertility fellowship program.