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Which infertility therapies work in women over age 40?

British researchers Armstrong and Akande review this issue in the Journal of Assisted Reproduction and Genetics published in 2013 (volume 30, pages 667-671).   They reviewed recent papers published in medical journals on the use of clomiphene, IUI, IUI using FSH medications and IVF in women over age 40.  These are common therapies used in women with infertility of all ages.  Their review focused on recent publications.  Most older papers published about infertility therapies do not distinguish women above age 40 from other women with infertility in spite of the fact that there are special issues that need to be considered for this group of women.

One of the major problems is that miscarriages are more frequent in women as they get older.  Women in their 20’s have miscarriages in up to 10% of recognized pregnancies.  When women are in their 40’s, their pregnancy loss rate exceeds 25%.  To evaluate the success of different therapies, you must know the associated delivery rates, since the pregnancy rate with a given therapy may be misleadingly high.   Many published trials do not provide information about delivery rates.

As indicated in the table from this paper presented below, for women over age 40, pursuing therapies other than IVF was found to be of very limited value.  The authors found that IVF provided the best chance of pregnancy for women in this age group.  They suggested that opting for ovulation induction using clomiphene or FSH with IUI can waste precious time and decrease chances of success with IVF.

Our approach to pregnancy in women over 40 (our Mini-stim IVF) uses low doses of medications, costs half as much as IVF and seems to be as effective as IVF.

Comparison of ART options for women aged 40

Treatments

compared

% Clinical pregnancy/cycle

% Live birth rate/cycle

Lead author of study cited (year)

Clomiphene

0.4%

Approx 0%

Tsafrir (2009)

Liu (2011)

IUI with clomiphene

14%

14.3%

< 1%

Unreported

Tsafrir (2009)

Dovey (2008)

IUI with FSH

3%

1%

Tsafrir (2009)

IVF

16.9%

13.7%

Wiser (2012)