Controlled ovarian stimulation with gonadotropins – what is the effect of woman’s age on success rates?

This study investigated factors that affect the fertility outcomes with intrauterine insemination (IUI) after controlled ovarian stimulation (COS).

They found that clinical pregnancy (CPR) and live birth rates (LBR) were associated with female age. 

Assisted reproduction (AR) is used to treat infertility. There are a number of AR options for infertile couples. Intrauterine insemination (IUI) is one of these. It involves delivering sperm directly to the uterus. IUI is less invasive and more affordable than in vitro fertilization (IVF). It is a popular first-line AR treatment. 

IUI may also involve controlled ovarian stimulation (COS). COS is used to stimulate the release of an egg from the ovary. COS is used in women that may not ovulate normally. Gonadotropins (GDTs) are one type of drug used for COS. Some studies suggest that fertility outcomes with IUI are poor. There is some evidence that IUI has a higher risk of multiple births. It is unclear if certain patients have better fertility outcomes with COS-IUI. 

This study included 2901 infertile couples. The total number of IUI procedures was 7359. All women underwent COS. GDTs were used for COS. IUI was performed 36 hours after COS. Fertility outcomes evaluated included clinical pregnancy (CPR) and live birth rates (LBR). 

The CPR was 9.38% for each cycle of COS-IUI. The LBR was 7.19%. The rate of twin pregnancies was 12.17%. CPR was not related to sperm count. There were no differences in fertility outcomes and male fertility parameters.

Female age was significantly associated with CPR and LBR. LBR was higher in women aged 37 or younger compared to those aged 38 or older. A lower LBR was also associated with women aged less than 30. The type of GDT used was not associated with fertility outcomes.

The authors concluded that CPR and LBR were associated with female age. The authors suggest that women aged 38 or older should consider further AR methods after a maximum of 3 IUIs during a six month period.

This study was based on medical records so certain information might have been missing. This study did not compare COS-IUI to other AR options. More controlled studies are needed. 

If you have any concerns regarding infertility please consult with your physician.