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Journal of Assisted Reproduction and Genetics

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22-06-2022 | Infertility | Review

Ovulation induction and intrauterine insemination in women of advanced reproductive age: a systematic review of the literature

Authors: Carleigh B. Nesbit, Misty Blanchette-Porter, Navid Esfandiari

Published in: Journal of Assisted Reproduction and Genetics | Issue 7/2022

Abstract

Purpose

The objective of this review is to define live birth rate (LBR) and clinical pregnancy rate (CPR) for women ≥ 40 undergoing ovulation induction (OI)/intrauterine insemination (IUI).

Methods

A systematic review was performed in accordance with PRISMA guidelines using PubMed and Google Scholar. The primary and secondary outcomes of interest were LBR and CPR, respectively.

Results

There were 636 studies screened of which 42 were included. In 8 studies which provided LBR for partner sperm, LBR/cycle ranged from 0 to 8.5% with majority being ≤ 4%. Cumulative LBR was 3.6 to 7.1% over 6 cycles with the majority of pregnancies in the first 4. In the four studies providing LBR for donor sperm cycles, LBR/cycle ranged from 3 to 7% with cumulative LBR of 12 to 24% over 6 cycles. The majority of pregnancies occurred in the first 6 cycles. There were three studies with LBR or CPR/cycle ≥ 1% for women ≥ 43. No studies provided data above this range for women ≥ 45. In 4 studies which compared OI/IUI and IVF, the LBR from IVF was 9.2 to 22% per cycle. In 7 studies which compared outcomes by stimulation protocol, no significant differences were seen.

Conclusion

For women ≥ 40 using homologous sperm, the highest probability of live birth is via IVF. However, if IVF is not an option, OI/IUI may be considered for up to 4 cycles in those using partner sperm or 6 cycles with donor sperm. For women > 45, OI/IUI is likely futile but a limited trial may be considered for psychological benefit while encouraging consideration of donor oocyte IVF or adoption. Use of gonadotropins does not appear to be more effective than oral agents in this age group.

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Title: Ovulation induction and intrauterine insemination in women of advanced reproductive age: a systematic review of the literature
Authors: Carleigh B. Nesbit
Misty Blanchette-Porter
Navid Esfandiari
Publication date: 22-06-2022
Publisher: Springer US
Keywords: Infertility
Infertility
Intrauterine Insemination
Endometriosis
Published in: Journal of Assisted Reproduction and Genetics / Issue 7/2022
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-022-02551-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ovulation induction and intrauterine insemination in women of advanced reproductive age: a systematic review of the literature

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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