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Infertility After 40: Don't Waste Time With IUI

For infertile women over 40, getting pregnant can be a challenge not to be taken likely. While many women gravitate toward less invasive fertility treatments, moving on to in vitro fertilization (IVF) sooner could be the best investment, financially and emotionally.

Depending on a woman’s diagnosis and age, multiple cycles of intrauterine insemination (IUI) could be a waste of time. Simon Kipersztok, M.D. of Shady Grove Fertility Center says “for women over 35, the maximum is three IUIs”. The reason being after three failed IUIs, the success rate is not much greater than timed intercourse would be for a woman of the same age. Kipersztok emphasizes that regarding age and fertility, it is best to move on to more advanced treatments. “Time is of the essence,” he says, “If you spend too much time on an intervention with a low success rate, by the time you do move to IVF your chances for success will be even lower than if you had begun with IVF.”

Despite current research that says IVF is the way to go, there are many reasons women over 40 hesitate to do IVF as a first line treatment. This is especially true for those holding out hope that they might just conceive the old-fashioned way. Additionally, those with infertility insurance coverage may feel bound by their policy's requirements to complete a number of less invasive treatments before moving on to IVF.

Dr. Kipersztok understands how this might impact an older patient’s willingness to do IVF. Insurance companies may be looking for the most cost efficient treatment option, not realizing in the long run IVF may be just that. “It can be difficult to deal with insurance companies if they are not up to date on the current infertility research. However, there is solid data out of Boston and New Hampshire that show it is much more cost effective to do IVF than IUI.” Conversely, there are a few insurance companies that refuse IUI and offer coverage for IVF, pushing patients of advanced maternal age to do the treatment with the least amount of time, money, and emotional expense.

The small picture is that one IUI cycle is a fraction of the cost of an IVF cycle. The average per cycle cost of IUI is about $900 but according to the Shady Grove data comes with approximately 8% success for the infertile woman over 40. The average IVF cycle runs just over $8,000 but offers a much higher success rate with fewer attempts. Many fertility clinics, like Shady Grove, offer discounted cycles and financing plans to offset the costs of fertility treatment for patients without infertility insurance coverage.

Dr. Kipersztok encourages patients over 40 with limited years of fertility to focus on the bigger picture: the goal of having a baby. “There is a double adverse effect when pursuing fertility treatments later in life; not only with the probability of conception, but moreover the increased rate of miscarriage. Women over 40 need to cooperate with their fertility doctors and go for interventions like IVF." Advanced technologies like IVF can provide optimal odds for successful live birth with fewer losses to the patient.

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