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What is already known on this topic Up to half of subfertile couples are diagnosed as having unexplained or mild male subfertility If these couples have unfavourable chances of natural conception, intrauterine insemination with controlled ovarian hyperstimulation is the first line treatment In vitro fertilisation with single embryo transfer or in vitro fertilisation in a modified natural cycle are alternative treatments that may prevent multiple pregnancies What this study adds In vitro fertilisation with single embryo transfer and in vitro fertilisation in a modified natural cycle were non-inferior to intrauterine insemination with controlled ovarian hyperstimulation in terms of the birth of a healthy child Rates of multiple pregnancy were comparable and low in the three group There seems to be no reason to abandon intrauterine insemination with controlled ovarian hyperstimulation as a first line treatment of couples with unexplained or mild male subfertility and an unfavourable prognosis for natural conception Cite this as: BMJ 2015;350:g7771 We thank all the couples who participated in this study. Tom Price says, if confirmed, he will commit to ensuring that Obamacare’s replacement plan provides a patient-centered system that revolves around Americans making choices for their own healthcare.

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