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

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 ≥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 ≥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 ≥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 ≥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 ≥40 years, no benefit after a single cycle of COH/IUI was observed. Women aged ≥40 years should be considered for in vitro fertilization after one failed COH/IUI cycle.

Key Words: Infertility, age, intrauterine insemination, live birth rate, ovulation induction, gonadotropin