Poor success of gonadotropin-induced controlled ovarian hyperstimulation and intrauterine insemination for older women.

Objective: To determine the success rates and utility of controlled ovarian hyperstimulation in conjunction with intrauterine insemination (COH/IUI) cycles in women aged 38-39 years versus women >or=40 years old.

Design: Retrospective cohort study.

Setting: Tertiary-care academic medical center.

Patient(s): There were 130 women, 57 aged 38-39 years (42.6%) and 73 aged >or=40 years (57.4%), who underwent 262 IUI cycles (range 1-3 cycles per woman).

Intervention(s): Infertility treatments with gonadotropins and IUI.

Main Outcome Measure(s): Clinical pregnancy rates and live birth rates stratified by age.

Result(s): The most common infertility diagnosis was diminished ovarian reserve, which was found more frequently among women aged >or=40 years than among the slightly younger group. The age-specific groups were similar in their baseline characteristics and cycle parameters. Women who were 38-39 years old had an overall live birth rate of 6.1% per cycle, with no live births occurring after the second cycle, and women >or=40 years old had an overall live birth rate of 2.0% per cycle, with all births occurring in the first cycle.

Conclusion(s): The efficacy of COH/IUI cycles significantly decreases with age, but women aged 38-39 years had reasonable success during the first two cycles. However, for women aged >or=40 years, no benefit after a single cycle of COH/IUI was observed. Women aged >or=40 years should be considered for in vitro fertilization after one failed COH/IUI cycle.