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

Abstract

Objective: To compare the success of ovulation induction using oral agents versus gonadotropins (GTs) in women ≥38 years old.

Study design: 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.

Results: 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).

Conclusions: 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.

Keywords: Controlled ovarian hyperstimulation (COH); Infertility; Intrauterine insemination (IUI); Older patients.