{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T22:57:45Z","timestamp":1772578665608,"version":"3.50.1"},"reference-count":49,"publisher":"Elsevier BV","issue":"6","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T00:00:00Z","timestamp":1653609600000},"content-version":"vor","delay-in-days":542,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","fertstert.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Fertility and Sterility"],"published-print":{"date-parts":[[2020,12]]},"DOI":"10.1016\/j.fertnstert.2020.10.029","type":"journal-article","created":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T09:49:30Z","timestamp":1606988970000},"page":"1141-1148","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":15,"title":["Should couples with unexplained infertility have three to six cycles of intrauterine insemination with ovarian stimulation or in\u00a0vitro fertilization as first-line treatment?"],"prefix":"10.1016","volume":"114","author":[{"given":"Willem","family":"Ombelet","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rik","family":"van Eekelen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aine","family":"McNally","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Ledger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Doody","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia","family":"Farquhar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.fertnstert.2020.10.029_bib1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s10815-012-9900-1","article-title":"Better IVF outcomes following improvements in laboratory air quality","volume":"30","author":"Khoudja","year":"2013","journal-title":"J Assist Reprod Genet"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib2","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.fertnstert.2010.03.030","article-title":"Optimizing the technique of embryo transfer","volume":"94","author":"Mains","year":"2010","journal-title":"Fertil Steril"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib3","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1080\/1464770312331369373","article-title":"The case for initial treatment with intrauterine insemination as opposed to in\u00a0vitro fertilization for idiopathic infertility","volume":"6","author":"Homburg","year":"2003","journal-title":"Hum Fertil (Camb)"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib4","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1093\/humupd\/dmx041","article-title":"IUI: review and systematic assessment of the evidence that supports global recommendations","volume":"24","author":"Cohlen","year":"2018","journal-title":"Hum Reprod Update"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib5","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1093\/oxfordjournals.humrep.a137622","article-title":"Slow release intrauterine insemination versus the bolus technique in the treatment of women with cervical mucus hostility","volume":"7","author":"Muharib","year":"1992","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib6","doi-asserted-by":"crossref","first-page":"7719","DOI":"10.1038\/s41598-020-64164-4","article-title":"Pregnancy rates after slow-release insemination (SRI) and standard bolus intrauterine insemination (IUI): a multicentre randomised, controlled trial","volume":"10","author":"Marschalek","year":"2020","journal-title":"Sci Rep"},{"issue":"Supp 1","key":"10.1016\/j.fertnstert.2020.10.029_bib7","first-page":"i25","article-title":"Patient-friendly insemination with homologous and donor sperm positively influences clinical pregnancy rates (Abstract)","volume":"32","author":"Bijnens","year":"2017","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib8","doi-asserted-by":"crossref","first-page":"127","DOI":"10.3109\/01443615.2013.853030","article-title":"Impact of unilateral tubal blockage diagnosed by hysterosalpingography on the success rate of treatment with controlled ovarian stimulation and intrauterine insemination","volume":"34","author":"Berker","year":"2014","journal-title":"J Obstet Gynaecol"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib9","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1159\/000434749","article-title":"Human papillomavirus positivity in women undergoing intrauterine insemination has a negative effect on pregnancy rates","volume":"81","author":"Depuydt","year":"2016","journal-title":"Gynecol Obstet Invest"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib10","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/j.fertnstert.2019.02.002","article-title":"Infectious human papillomavirus virions in semen reduce clinical pregnancy rates in women undergoing intrauterine insemination","volume":"111","author":"Depuydt","year":"2019","journal-title":"Fertil Steril"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib11","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1093\/humrep\/dev193","article-title":"Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?","volume":"30","author":"Tjon-Kon-Fat","year":"2015","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib12","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1093\/humrep\/dey268","article-title":"Follicle stimulating hormone versus clomiphene citrate in intrauterine insemination for unexplained subfertility: a randomized controlled trial","volume":"33","author":"Danhof","year":"2018","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib13","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/S0140-6736(17)32406-6","article-title":"Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open label, randomised, controlled, two-centre trial","volume":"93","author":"Farquhar","year":"2018","journal-title":"Lancet"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib14","doi-asserted-by":"crossref","first-page":"g7771","DOI":"10.1136\/bmj.g7771","article-title":"Prevention of multiple pregnancies in couples with unexplained or mild male subfertility: randomised controlled trial of in\u00a0vitro fertilisation with single embryo transfer or in\u00a0vitro fertilisation in modified natural cycle compared with intrauterine inse","volume":"350","author":"Bensdorp","year":"2015","journal-title":"BMJ"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/humupd\/dmz035","article-title":"IUI for unexplained infertility-a network meta-analysis","volume":"26","author":"Danhof","year":"2020","journal-title":"Hum Reprod Update"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib17","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.rbmo.2015.02.006","article-title":"Cost-effectiveness of assisted conception for male subfertility","volume":"30","author":"Moolenaar","year":"2015","journal-title":"Reprod Biomed Online"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib18","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.rbmo.2019.09.004","article-title":"Gonadotrophins or clomiphene citrate in couples with unexplained infertility undergoing intrauterine insemination: a cost-effectiveness analysis","volume":"40","author":"Danhof","year":"2020","journal-title":"Reprod Biomed Online"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib19","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-034566","article-title":"Observational retrospective study of UK national success, risks and costs for 319,105 IVF\/ICSI and 30,669 IUI treatment cycles","volume":"10","author":"Bahadur","year":"2020","journal-title":"BMJ Open"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib20","doi-asserted-by":"crossref","first-page":"hoz044","DOI":"10.1093\/hropen\/hoz044","article-title":"Survey on ART and IUI: legislation, regulation, funding and registries in European countries: the European IVF-monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE)","volume":"2020","author":"Calhaz-Jorge","year":"2020","journal-title":"Hum Reprod Open"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib21","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1093\/humupd\/dmn042","article-title":"Infertility and the provision of infertility medical services in developing countries","volume":"14","author":"Ombelet","year":"2008","journal-title":"Hum Reprod Update"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib22","first-page":"65","article-title":"IVF in Africa: what is it all about?","volume":"11","author":"Ombelet","year":"2019","journal-title":"Facts Views Vis Obgyn"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib23","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/S0140-6736(02)09417-5","article-title":"Female subfertility","volume":"360","author":"Evers","year":"2002","journal-title":"Lancet"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib24","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1093\/humrep\/deh365","article-title":"Two new prediction rules for spontaneous pregnancy leading to live birth among subfertile couples, based on the synthesis of three previous models","volume":"19","author":"Hunault","year":"2004","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib25","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1016\/S0140-6736(00)02320-5","article-title":"Variation in couple fecundity and time to pregnancy, an essential concept in human reproduction","volume":"355","author":"Te Velde","year":"2000","journal-title":"Lancet"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib26","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1093\/humrep\/dew309","article-title":"Natural conception: repeated predictions over time","volume":"32","author":"Van Eekelen","year":"2017","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib27","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s10680-009-9201-2","article-title":"Using split-population models to examine predictors of the probability and timing of parity progression","volume":"26","author":"Gray","year":"2010","journal-title":"Eur J Population"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib28","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1093\/humrep\/dex214","article-title":"A prognosis-based approach to infertility: understanding the role of time","volume":"32","year":"2017","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib29","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.1093\/humrep\/dex311","article-title":"Constructing the crystal ball: how to get reliable prognostic information for the management of subfertile couples","volume":"32","author":"Van Eekelen","year":"2017","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib30","doi-asserted-by":"crossref","first-page":"g252","DOI":"10.1136\/bmj.g252","article-title":"Are we overusing IVF?","volume":"348","author":"Kamphuis","year":"2014","journal-title":"BMJ"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib31","doi-asserted-by":"crossref","first-page":"2665","DOI":"10.1093\/humrep\/dew241","article-title":"IUI and IVF for unexplained subfertility: where did we go wrong?","volume":"31","author":"Tjon-Kon-Fat","year":"2016","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib32","article-title":"Interventions for unexplained infertility: a systematic review and network meta-analysis","volume":"9","author":"Wang","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib33","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.1093\/humrep\/deaa158","article-title":"Cost-effectiveness of medically assisted reproduction or expectant management for unexplained subfertility: when to start treatment?","volume":"35","author":"Van Eekelen","year":"2020","journal-title":"Human Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib34","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1093\/humrep\/deaa129","article-title":"Age-related natural fertility outcomes in subfertile women over 35: an individual participant data meta-analysis","volume":"35","author":"Chua","year":"2020","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib35","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1093\/humrep\/dez072","article-title":"IVF for unexplained subfertility; whom should we treat?","volume":"34","author":"Van Eekelen","year":"2019","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib36","series-title":"Decision modelling for health economic evaluation","author":"Briggs","year":"2006"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib38","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1016\/S0140-6736(83)91148-0","article-title":"Current status of in\u00a0vitro fertilisation and implantation of human embryos","volume":"2","author":"Edwards","year":"1983","journal-title":"Lancet"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib39","series-title":"Assisted reproductive technology in Australia and New Zealand 2017","author":"Newman","year":"2019"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib41","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.rbmo.2014.10.004","article-title":"Should IVF be used as a firstling treatment or as a last resort. A debate presented at the 2013 Canadian Fertility and Andrology Society meeting","volume":"30","author":"Huang","year":"2015","journal-title":"Reprod Biomed Online"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib42","article-title":"Intra-uterine insemination for unexplained subfertility","volume":"3","author":"Ayeleke","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib43","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1111\/j.1479-828X.2010.01155.x","article-title":"Is in\u00a0vitro fertilisation more effective than stimulated intrauterine insemination as a first line therapy for subfertility? A cohort analysis","volume":"50","author":"Chambers","year":"2010","journal-title":"Aust NZ J Obstet Gynaecol"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib47","doi-asserted-by":"crossref","first-page":"156.e1","DOI":"10.1016\/j.ajog.2013.10.005","article-title":"Healthcare expenses associated with multiple vs singleton pregnancies in the United States","volume":"209","author":"Lemos","year":"2013","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib48","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/S0140-6736(06)69042-9","article-title":"Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained infertility and an intermediate prognosis: a randomised clinical trial","volume":"368","author":"Steures","year":"2006","journal-title":"Lancet"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib49","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/humupd\/dmn034","article-title":"The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a meta-analysis","volume":"14","author":"Van Rumsle","year":"2008","journal-title":"Hum Reprod Update"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib50","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1093\/humrep\/deaa030","article-title":"Cumulative live birth rates for women returning to ART treatment for a second ART conceived child","volume":"35","author":"Paul","year":"2020","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib51","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1055\/s-0030-1265676","article-title":"Ovarian hyperstimulation treatment prevention strategies: use of gonadotrophin-releasing hormone antagonists","volume":"28","author":"Greisenger","year":"2010","journal-title":"Semin Reprod Med"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib52","doi-asserted-by":"crossref","first-page":"2305","DOI":"10.1093\/humrep\/dex298","article-title":"Cultural determinants influence assisted reproduction usage in Europe","volume":"32","author":"Prag","year":"2017","journal-title":"Hum Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib53","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1093\/biolre\/ioz161","article-title":"The forgotten men: Rising rates of male infertility urgently require new approaches for its prevention, diagnosis and treatment","volume":"101","author":"Ravitsky","year":"2019","journal-title":"Biol Reprod"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib54","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.rbmo.2009.10.017","article-title":"Modified natural cycle IVF and mild IVF: a 10 year Swedish experience","volume":"20","author":"Aanesen","year":"2010","journal-title":"Reprod Biomed Online"},{"key":"10.1016\/j.fertnstert.2020.10.029_bib55","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.fertnstert.2013.03.037","article-title":"Utilization and success rates of unstimulated in\u00a0vitro fertilisation in the United States: an analysis of the Society for Reproductive Technology database","volume":"100","author":"Gordon","year":"2013","journal-title":"Fertil Steril"}],"container-title":["Fertility and Sterility"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0015028220325437?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0015028220325437?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T08:28:38Z","timestamp":1758011318000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0015028220325437"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":49,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["S0015028220325437"],"URL":"https:\/\/doi.org\/10.1016\/j.fertnstert.2020.10.029","relation":{},"ISSN":["0015-0282"],"issn-type":[{"value":"0015-0282","type":"print"}],"subject":[],"published":{"date-parts":[[2020,12]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Should couples with unexplained infertility have three to six cycles of intrauterine insemination with ovarian stimulation or in\u00a0vitro fertilization as first-line treatment?","name":"articletitle","label":"Article Title"},{"value":"Fertility and Sterility","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.fertnstert.2020.10.029","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"simple-article","name":"content_type","label":"Content Type"},{"value":"\u00a92020 Published by Elsevier Inc. on behalf of the American Society for Reproductive Medicine","name":"copyright","label":"Copyright"}]}}