Success rates from 390 cycles of gonadotropin/IUI in women aged 40 and above

Over the past twenty years, an increasing number of women have chosen to delay childbearing until the fourth and fifth decades of life. Substantial age-related declines in female fertility have been well established. Ovulation induction combined with intrauterine insemination (IUI) is an important treatment modality in this group of women, and often precedes the use of the more expensive assisted reproductive techniques such as IVF. Infertile women 40 years and older are less successful in achieving pregnancy than women under 40, when comparing any individual treatment modality. Previous studies have reported pregnancy rates ranging from 5.4–17.9% for women undergoing gonadotropin stimulation with IUI in this age group. This study presents success rates of 390 cycles of gonadotropin/IUI in 160 women aged 40 years and older. Retrospective chart review. 390 cycles of women undergoing gonadotropin/IUI at Boston IVF between March of 1996 and April of 2003 were reviewed. All patients were between 40.0 and 46.6 years old. The majority of cycles (87.4%) were not downregulated, 10.7% of cycles were downregulated with leuprolide acetate, and in 1.1% of cycles a GnRH antagonist was administered. The remaining cycles utilized OCPs. The following cycle characteristics were analyzed: age of woman, CD3 FSH levels, peak E2 values, number of mature follicles, +hCG, and clinical pregnancy rate. The clinical pregnancy rate (PR) per cycle start in women aged 40–43 undergoing gonadotropin/IUI was 5.2%, as shown in Table 1. Only 1 pregnancy occurred in 61 cycles above age 44(at age 45). Characteristics of cycles in those women with a clinical pregnancy compared to those not pregnant are shown in Table 2. The loss rate from positive pregnancy to clinical pregnancy approached 50%.*Clinical pregnancy is defined by the presence of cardiac activity via transvaginal ultrasound An overall clinical pregnancy rate of 5.2% (n=17) was observed in women aged 40–43 years in our cohort. Only one pregnancy occurred beyond age 44. This compares with an IVF pregnancy rate of 15.9% in women aged between 40–43 years at our center. The low success rate of gonadotropin/IUI in this retrospective study raises the question of whether this treatment modality is any better than clomiphene citrate/IUI, and whether IVF is significantly more efficacious than either. This study lends support to our present NIH-sponsored trial (FORTT) comparing the outcomes of these 3 treatment options.View Large Image Figure ViewerDownload Hi-res image Download (PPT)