Poor success of gonadotropin-induced controlled ovarian hyperstimulation and intrauterine insemination for older women

Fertil Steril. 2010 Jun;94(1):144-8. doi: 10.1016/j.fertnstert.2009.02.040. Epub 2009 Apr 25.

Abstract

Objective: To determine the success rates and utility of controlled ovarian hyperstimulation in conjunction with intrauterine insemination (COH/IUI) cycles in women aged 38-39 years versus women >or=40 years old.

Design: Retrospective cohort study.

Setting: Tertiary-care academic medical center.

Patient(s): There were 130 women, 57 aged 38-39 years (42.6%) and 73 aged >or=40 years (57.4%), who underwent 262 IUI cycles (range 1-3 cycles per woman).

Intervention(s): Infertility treatments with gonadotropins and IUI.

Main outcome measure(s): Clinical pregnancy rates and live birth rates stratified by age.

Result(s): The most common infertility diagnosis was diminished ovarian reserve, which was found more frequently among women aged >or=40 years than among the slightly younger group. The age-specific groups were similar in their baseline characteristics and cycle parameters. Women who were 38-39 years old had an overall live birth rate of 6.1% per cycle, with no live births occurring after the second cycle, and women >or=40 years old had an overall live birth rate of 2.0% per cycle, with all births occurring in the first cycle.

Conclusion(s): The efficacy of COH/IUI cycles significantly decreases with age, but women aged 38-39 years had reasonable success during the first two cycles. However, for women aged >or=40 years, no benefit after a single cycle of COH/IUI was observed. Women aged >or=40 years should be considered for in vitro fertilization after one failed COH/IUI cycle.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Factors
  • Birth Rate / trends
  • Cohort Studies
  • Female
  • Gonadotropins / administration & dosage*
  • Gonadotropins / adverse effects
  • Humans
  • Insemination, Artificial / methods
  • Insemination, Artificial / trends*
  • Male
  • Middle Aged
  • Ovarian Hyperstimulation Syndrome* / chemically induced
  • Ovulation Induction / methods
  • Ovulation Induction / trends*
  • Pregnancy
  • Retrospective Studies
  • Uterus / drug effects

Substances

  • Gonadotropins