After discussing the options for fertility treatment with couples, there are many who opt to try a “first-line” treatment, such as intrauterine insemination (IUI) and/or ovulation induction with fertility drugs before moving on to more advanced assisted reproduction, such as in vitro fertilization (IVF). These treatments simply increase the chances of natural conception without actually manipulating the fertilization process, and they can be successful for some couples.
However, in the case of couples of older reproductive age — women between 38 and 42 years old — who have unexplained infertility, these first-line treatments may not be the best course of action. A recent study found that for these couples, going straight to in vitro fertilization (IVF) is the most efficient treatment and results in fewer treatment cycles and a higher live birth rate.
Researchers at Boston IVF and Brigham and Women’s Hospital found that the women in the study were more than twice as likely to become pregnant through IVF within their first two cycles of treatment, and they were twice as likely to have a successful birth from that pregnancy.
The study was a National Institutes of Health funded, randomized clinical trial of 154 couples who had to have been trying to conceive for at least six months and to not have previously tried any fertility treatments being used in the study. The female partner had to be between 38 and 42 with regular menstrual cycles, at least one ovary and fallopian tube, an acceptable ovarian reserve, no disorders of the reproductive organs and no history of ectopic pregnancy.
The couples were randomly assigned to one of three groups to receive treatment for their first two cycles.
- One group received IVF
- One group received IUI with the female partner receiving either an oral medication to induce ovulation (clomiphene citrate)
- One group received IUI with the female partner receiving injectable fertility drugs to induce ovulation (follicle stimulating hormone)
After two cycles of the assigned treatment, the researchers found the following:
- Of patients who went straight to IVF, 49 percent became pregnant, and 31 percent gave birth.
- Of those with IUI and oral medication, 22 percent became pregnant, and 16 percent gave birth.
- Of those with IUI and injectable medication, 17 percent became pregnant and 14 percent gave birth.
The couples who did not become pregnant via IUI were subsequently given treatment with IVF, and at the end, of all the couples in the study, 71 percent had experienced a clinical pregnancy, and 46 percent gave birth. The clear majority of the live births (84 percent) were the result of IVF, and those couples who started with IVF took an average of two cycles to conceive, while those who started with IUI averaged three to four cycles.
When older couples are experiencing unexplained infertility, time is of the essence, and moving more quickly to the most effective treatment is the best way to achieve the family you have dreamed of.