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Poor Success with IUI and Ovulation Induction in Women over 40
Title: Ovulation induction and IUI in older women
Authors: Dickey,R. et al.
Address: New Orleans, Louisiana
Source: Human Reproduction 12:199, 1997 (January)
Summary: The results of 466 completed cycles of IUI with and without therapy for ovulation induction were reported. Altogether, there were 29 clinical pregnancies and 13 births. Clomiphene therapy was as useful as gonadotropin injections alone, or in combination with clomiphene. The pregnancy rate in 43-45 year olds was one half that of those age 40-42. The abortion rate was 57% in all patients . No pregnancies were reported regardless of therapy in patients over age 45.
Comment: There appears to be a predicted and real accelerated decline in fertility after age 38 and the average age of last birth in women using no contraception is about age 41. Women who have had pelvic disease or surgery may show a decline even at an earlier age. Despite our best efforts as physicians and the strong will of our patients, this age-related decline in fertility seems predictable and absolute. Women over age 38 should have a FSH level drawn on cycle day 3. In most US assays, levels above 20 are associated with almost certain failure at any form of therapy. Between 10-20 IU/L success is marginal. Age alone is not an absolute marker and the only way to predict outcome of therapy is to try. Prolonged, or multiple, attempts are usually futile. Still, many of these patients are excellent candidates for oocyte donation.