Ovulation induction combined with intrauterine insemination in women 40 years of age and older: is it worthwhile?

Abstract

The use of ovulation induction combined with intrauterine insemination (IUI) as a treatment for subfertility in women with patent Fallopian tubes has increased in recent years. Little is known regarding the efficacy of this treatment in women aged >/=40 years. We reviewed our data in our ovulation induction with IUI programme for 168 consecutive patients aged >/=40 years undergoing a total of 469 cycles of treatment. Either sequential clomiphene citrate and human menopausal gonadotrophins or daily gonadotrophins were utilized along with timed IUI insemination. In 402 completed cycles, 28 clinical pregnancies occurred. The pregnancy loss rate was 34.4%. The overall ongoing/viable pregnancy rates per initiated and completed cycles were 4.47 and 5.22% respectively. No viable pregnancies occurred in 136 cycles in women aged >/=43 years. The ongoing/variable cycle fecundity rates for women aged 40, 41, and 42 years were 9.6, 5.2, and 2.4% per cycle respectively. When utilized in women aged >=40 years, ovulation induction with IUI is most likely to result in successful pregnancy in women 40-42 years of age. Women >/=43 years should consider other alternatives such as adoption or egg donation.

Intrauterine insemination with husband semen: an evaluation of pregnancy rate and factors affecting outcome

“…The reported live birth rates following IUI in women aged 40 years are low, varying from 1.4% to 5.2% [19,20]. The age-related decline in female fecundity has been well documented in every aspect of natural and artificial reproduction [21], and probably results from a combination of progressive follicular depletion, decline in granulosa function, poor oocyte quality [22] and reduced endometrial receptivity [23].…”

What is the best treatment option for infertile women aged 40 and over?

“…The results reveal a pregnancy rate of 1-4 % per cycle and the delivery rates are almost never reported. A further retrospective review of livebirths resulting from ovulation-induction and IUI in women aged 40 and over was performed by Corsan et al in 1996. The results were similarly disappointing, reporting a low probability of livebirth in women undergoing this treatment aged 40-41 with no live births seen in women aged >42 years old [28].…”

“…A further retrospective review of livebirths resulting from ovulation-induction and IUI in women aged 40 and over was performed by Corsan et al in 1996. The results were similarly disappointing, reporting a low probability of livebirth in women undergoing this treatment aged 40-41 with no live births seen in women aged >42 years old [28]. Dovey et al undertook a large retrospective cohort study examining the pregnancy rate per completed cycle of women receiving clomiphene citrate and IUI according to their age.…”

Female Age in ART: When to Stop?

“…Therefore, 15 studies were finally selected to contribute to the analysis. Table 1 summarizes the key information extracted from these studies [49,[53][54][55][56][57][58][59][60][61][62][63][64][65][66]. The vast majority of the intrauterine insemination cycles were combined with mild to moderate ovarian stimulation by the use of exogenous gonadotropins and/or oral clomiphene citrate and/or sequential clomiphene citrate/gonadotropins.…”