Do oral ovulation induction agents offer benefits in women 38 to 43 years of age undergoing insemination cycles?

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 258; pp. 273 - 277
• Main Authors: Steiner, Naama, Ruiter-Ligeti, Jacob, Frank, Russell, Al Shatti, Maryam, Badeghiesh, Ahmad, Rotshenker-Olshinka, Keren, Buckett, William, Dahan, Michael H.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.03.2021
• Subjects: Adult; Clomiphene - therapeutic use; Controlled ovarian hyperstimulation (COH); Female; Fertility Agents, Female; Humans; Infertility; Infertility, Female; Insemination, Artificial; Intrauterine insemination (IUI); Older patients; Ovulation Induction; Pregnancy; Pregnancy Rate; Retrospective Studies; Controlled ovarian hyperstimulation (COH); Older patients; Intrauterine insemination (IUI); Infertility
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2021.01.012

To compare the success of ovulation induction using oral agents versus gonadotropins (GTs) in women ≥38 years old. A retrospective cohort study was performed including all first to third stimulated IUI cycles conducted after the age of 38 years in a single academic fertility center between 01/2011 and 03/2018. A total of 1596 IUI cycles were included. 240 cycles were with clomiphene citrate (CC), 176 letrozole cycles and 1180 gonadotropin (GTs) cycles. The GTs group were older (p < 0.001), had lower antral follicular count (p < 0.001), and thicker endometrium (p < 0.001) compared to the oral agent groups. The letrozole group had a less mature follicles (p = 0.004) at the time of triggering compared to the other groups. No difference in pregnancy or clinical pregnancy rates was observed after controlling for confounders when comparing the 3-groups. 5 multiple pregnancies occurred, all in the GTs group. The groups were subdivided by age; 38–39 years old (N = 750) and 40–43 years old (N = 846). Nevertheless, no statistical difference was observed in pregnancy rates and clinical pregnancy rates between oral agents and GTs when controlling for the confounding effects among women at age 38–39 (p = 0.47, p = 1.0; respectively) and among women 40–43-years-old (p = 0.16, p = 1.0; respectively). Clearly costs of oral agents are lower and they are more patient friendly than GTs, therefore oral agents should be first line for ovarian stimulation and IUI in women 38–43-years of age.