If you’re over the age of 40 and wondering which fertility treatment is right for you, you might find that in vitro fertilization (IVF), not intrauterine insemination (IUI), is your best bet for getting pregnant. Research presented by Shady Grove Fertility Reproductive Center at the 68th Annual Meeting of the American Society for Reproductive Medicine (ASRM) suggests older women trying to conceive move straight to IVF to maximize their odds for success and minimize their financial and emotional losses.
IUI cycles typically involve ovarian stimulation via fertility drugs, though they can be non-medicated cycles if the woman is ovulating regularly on her own. Throughout the cycle, the woman is monitored with blood work to check hormone levels and ultrasound to check follicular development. In a medicated cycle, the fertility doctor will look for approximately 3 mature follicles before triggering ovulation. The male partner will be instructed to provide a sperm sample, or donor sperm will be used, which will be washed and inserted into the uterus using a catheter and syringe. Depending on age and diagnosis, an IUI can have a success rate of up to 17 percent. Women over 40 might see success rates less than half of that.
In vitro fertilization (IVF) cycles allow for much greater control of ovarian stimulation and egg fertilization. IVF patients will receive blood work and ultrasound monitoring similar to an IUI cycle during the stimulation process. The goal of IVF is to produce greater quantity, good quality eggs, so more follicles may be present and more will be retrieved. The male partner or donor’s sample will be washed and combined with the eggs in a lab to achieve fertilization. In many cases, intracytoplasmic sperm injection (ICSI) may be employed instead to ensure each egg is fertilized by one sperm. Embryos are then monitored for growth and transferred back into the uterus several days later. The success rates for IVF can be found by visiting the Society for Assisted Reproductive Technology (SART) website and vary per clinic.
Researchers at Shady Grove found that for women ages 38 to 44, IVF was much more effective than IUI. Data collected from over 7,602 IUI cycles in over 4,000 women diagnosed with unexplained infertility showed that pregnancy is achievable via Clomid or injectable IUI cycles at similar rates for women between 21-40 years old. However, the IUI pregnancy rate is much lower for study participants ages 41-46, suggesting IVF yields the quickest route to motherhood for those over 40. After completing an average of 1.5 IUI cycles, women under 40 ranged between 47% and 65% for ongoing pregnancy rates, while those over 40 only reached 24% ongoing pregnancy success.
The team then examined data from a retrospective cohort study which looked at 3,653 IVF cycles and 2,717 IUI cycles performed for women ranging between 38-44 years of age diagnosed with unexplained infertility or diminished ovarian reserve (DOR). Pregnancy and subsequent births were 2.5 times higher for IVF patients than IUI patients.
President of the Society for Reproductive Endocrinology and Infertility, Dr. Brad Van Voorhis, tells us, “While intrauterine insemination may be a less invasive treatment, there are definite advantages to IVF for women in their later reproductive years who are experiencing unexplained infertility”. Despite the fact that IVF is a more arduous treatment for fertility, it is the more efficient option for older women who feel the pressure of the loudly ticking biological clock. Many cost-conscious people hesitate to discuss IVF with their doctors, but they may find greater savings in the long run by pursuing IVF. Similarly, those with insurance coverage might be covered for IVF sooner than the required 3 IUI cycles, provided their doctor can justify the procedure’s cost and time efficiency to the insurance company.