Is intrauterine insemination a valid option for initial treatment of infertility in women aged 40-42? (Pro & Con).

YES Intrauterine insemination is indeed an option in women aged 40-42.

We know that advancing age decreases the success of reproductive technologies as well as the success of pregnancy; the rates of spontaneous pregnancy loss increase steadily with age. In fact, at the age of 42 the risk of pregnancy loss is greater than 50%, and after age 45 the risk is nearly 75%.

Older patients can benefit from early and aggressive use of assisted reproductive technologies. Since success rates with in vitro fertilization, a much more expensive option than intrauterine insemination (IUI)--decline beginning as early as age 30--my colleagues and I decided to evaluate the efficacy of IUI in the older female patient.

We conducted a retrospective review of 1,117 IUI cycles between 1995 and 1999, which resulted in 217 pregnancies. The live birth rate was 12.9% per cycle inseminated, for a total of 134 live births (Fertil. Steril. 78[1]:29-33, 2002).

In the over 40 age group, the live birth rate per insemination was 8.5%, and the pregnancy rate was 17.9% per insemination. The oldest patient who achieved pregnancy was 46, and the oldest to have a live birth was 44. In the 40-42 age group, the live birth rate per insemination was 9.8%.

We found that while live birth rates per insemination declined with advancing age, the pregnancy rate per insemination did not change substantially between the ages of 30 and over 40. The live birth rate declined largely due to the increase in spontaneous pregnancy loss with advancing age. The live birth rate of 9.8% in women aged 40-42 is acceptable, and the use of a GnRH-agonist suppression cycle for IUI was associated with a live birth rate of 12.5% per insemination. After age 42, that rate declined sharply to only 4.2%.

Based on these findings, it appears reasonable to include IUI among the possible treatments for infertility in women aged 40-42 in whom male factor infertility has been ruled out as the cause of infertility and in whom no tubal disease is evident.