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Upping The Fertility Odds for Older Women

Ever wonder when to start IVF? Feel confused about the differing information about the quickest path to a family? You are not alone. Women who have trouble conceiving naturally are faced with many choices and unless you have a wealth of time and an encyclopedic brain, it's hard to sort out how to best move toward this longed-for goal. And while, generally, most women are now aware that the older they are, the lower their odds of having a healthy baby, many are not sure when to move from less radical (and often less effective) treatments like intrauterine insemination (IUI) combined with ovary-stimulating fertility drugs to IVF.

New research now offers some definitive answers—at least for women between the ages of 38 and 42. A study done at Boston IVF and Brigham and Women’s Hospital looked at 154 couples receiving infertility treatment who were randomly assigned to three groups. One group immediately underwent IVF while the other two groups did IUIs while receiving either an oral or injectable medication to induce ovulation. All couples had been trying to conceive for at least 6 months and none had ever had any of these fertility treatments.

The results were clear: immediate IVF was the most effective treatment. After two cycles, 49% of the patients who went straight to IVF were pregnant versus 22% of those being treated with IUI and oral medication and 17% of those with IUI and injectable medications. Plus, 31% of the IVF group gave birth, a number nearly double the rate of the other two groups.

Those are interesting numbers, but perhaps the most striking statistic to come out of the study was that when it was over, 84% of all live births came about as a result of IVF. Dr. Richard Reindollar, the study’s principal investigator when he was at Dartmouth Hitchcock Medical Center (DHMC), says that’s a high number. “When I actually looked at total percentage of babies that came from IVF, I was surprised,” says Reindollar. “I just didn’t think that of all the babies that came out of this trial it would be that many from IVF—and to me that summarizes the study outcome."

Reindollar, who is now Executive Director of the American Society for Reproductive Medicine (ASRM), also says he understands that some people will not want to proceed straight to IVF--either because they have issues with the high tech procedure or because they can’t afford it. He says that for those who opt for ovarian stimulation combined with IUI, the study also had some specific and helpful findings.

“For those couples who elect to start with fertility drugs combined with intrauterine inseminations, our data suggests that it makes more sense to use an oral medication like clomiphene versus the injectable ovulation drugs, given the higher pregnancy rates shown with the orals and the higher cost of treatment when using the injectables.”

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