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Older women with unexplained infertility might consider skipping fertility drugs and going directly to in-vitro fertilisation, in light of new study findings.
In a randomised trial involving 154 women between the ages of 38 and 43, those who underwent immediate IVF had a pregnancy rate of 24.7% after two cycles, more than three times as high as the rate with the two fertility drugs tested.
"This would suggest that immediate IVF is the most effective treatment for women at the end of reproduction who still have a chance for success," Dr Richard Reindollar, who led the study at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, said.
"For the younger patients it makes a lot more sense to start with drugs and insemination and move on to IVF. For the older women, whose time is shorter, it doesn't make as much sense to start with drugs first," Dr Reindollar said.
He and his team presented their results at the American Society for Reproductive Medicine's annual meeting in Orlando, Florida.
Three arms
The study had three arms: two cycles of clomiphene and intrauterine insemination (51 couples completed 87 cycles combined), two cycles of follicle-stimulating hormone injections and IUI (52 couples completed 91 cycles combined), or immediate IVF (51 couples, 85 cycles).
The two drug groups together had a pregnancy rate of 7.3% (7.9% with clomiphene and 7.7% with FSH), compared to the IVF group at 24.7% (p=0.0008). The live birth rates were 5.1% in the drug groups and 15.3% in the IVF group (p=0.0172).
In a second phase of the trial, couples who did not get pregnant moved on from the drug groups to try IVF, with greater success. In the clomiphene group, 83% of those who had a live birth had it through IVF, and in the FSH group, 70% eventually had their child through IVF.
In total, IVF accounted for more than 70% of all the babies born.
"The couples that started with immediate IVF got pregnant through statistically fewer treatment cycles," Dr Reindollar said.
"Given that an older woman's eggs are more fragile, the logic goes that it might be better to spare them the trauma of being sucked through a tube, dumped into a petri dish and roughed up in a number of other ways," said Dr Nanette Santoro, a reproductive endocrinologist at the University of Colorado, Denver, who was not involved in the study. "So the clear-cut preliminary finding that IVF works best puts that notion to rest.
"Dr Reindollar's work is pushing the field towards doing more IVF earlier in the process, which is a natural evolution of the technology," she said. "It is just the most effective treatment out there."
(Reuters Health, Rob Goodier, October 2011)
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