Ovulatory disorders can arise from any level of the hypothalamic-pituitary-ovarian axis. Ovulatory dysfunction may result from a lack of available oocytes or of follicles. Pelvic imaging, which is often undertaken at the time of examination by transvaginal ultrasound scan, can confirm normal pelvic organs and also provide an assessment of ovarian morphology, in particular polycystic appearance. Semen analysis for the male partner must be considered an absolute minimum. It is important to consider tubal patency if ovulation induction is planned and, in women with risk factors for tubal disease, prior assessment should be considered mandatory either by laparoscopy or contrast imaging. Liaison with endocrine colleagues is recommended when more complex endocrine disorders are involved. General fertility advice is important, including advice (for both partners) on weight management, smoking, alcohol and drugs, as is confirming an up-to-date smear result and female folic acid supplementation.

Expectant management has a key role in the management of unexplained infertility. The decision to treat couples with unexplained infertility should take into account their chances of spontaneous conception, which is affected by female age, duration of infertility and occurrence of a previous pregnancy. The rationale for the use of oral clomifene citrate in unexplained infertility is the belief that it corrects subtle ovulatory dysfunction and encourages the release of more than one oocyte. Clomifene is inexpensive, non-invasive and requires little clinical monitoring, but it can cause multiple pregnancies, including high-order multiples. Intrauterine insemination (IUI) has been used widely for the treatment of unexplained infertility. It is thought to enhance the chance of pregnancy by increasing the number of motile spermatozoa within the uterus, bringing them in close proximity to the oocyte. Although more effective than IUI, superovulation (SO) along with IUI is associated with high rates of multiple births.