Comparison of outcomes of KOH/IUI and IVF treatment in advanced age infertile women

Abstract

Objective: The aim of the study was to compare the outcomes of patients >38 years of age who underwent COH/IUI and those who underwent IVF treatment.

Material and Method: 113 patients who meet the inclusion criteria were enrolled into the study. Of the 113 patients; 42 patients who underwent KOH/IUI and 71 patients who underwent IVF treatment. The biochemical, clinical and ongoing pregnancy rates were compared between two groups.

Results: There were significant differences in terms of biochemical and clinical pregnancy rates between two groups and those were higher in IVF treatment (p1=0.033, p2=0.031). Ongoing pregnancy rate was higher in IVF treatment group but there was no significant difference between two groups (p=0.084).

Conclusion: IVF treatment may be first line treatment option in advanced age women because of the higher success rates of IVF treatment than COH/IUI treatment.

Keywords

• In vitro fertilization
• intrauterine insemination
• advanced age

İleri yaş infertil kadınlarda KOS/IUI ile IVF tedavilerinin sonuçlarının karşılaştırılması

Öz

Amaç: Çalışmada 38 yaş üzeri infertil kadınlarda KOS/IUI ile IVF tedavilerinin sonuçlarının karşılaştırılması amaçlanmaktadır.

Gereç ve Yöntem: 38 yaş üzerindeki KOS/IUI veya IVF tedavisi alan toplam 113 infertil kadın bu retrospektif çalışmaya dahil edilmiştir. Çalışmada KOS/IUI tedavisi uygulanmış 42 hasta, IVF tedavisi uygulanmış 71 hasta bulunmaktadır. İki grup biyokimyasal gebelik, klinik gebelik ve devam eden gebelik sonuçları açısından karşılaştırıldı.

Bulgular: İki grup arasında biyokimyasal gebelik ve klinik gebelik oranları arasında istatistiksel olarak anlamlı düzeyde farklılık saptandı. Biyokimyasal gebelik ve klinik gebelik oranları IVF tedavisi alan grupta daha yüksekti (p1=0.033, p2=0.031). Devam eden gebelik oranı IVF tedavisi alan grupta daha yüksek olmasına rağmen iki grup arasında istatistiksel derecede anlamlı bir fark saptanmadı (p=0.084).

Sonuç: İleri yaş grubundaki hastalarda IVF tedavisi KOS/IUI tedavisinden daha etkin olması nedeniyle bu yaş grubundaki hastalarda ilk tedavi seçeneği olarak IVF tedavisinin uygulanabileceğini düşünmekteyiz.

Anahtar Kelimeler

• in vitro fertilization
• intrauterine inseminasyon
• ileri yaş

Kaynakça

1. Botting B, Dunnell K. Trends in fertility and contraception in the last quarter of the 20th century. Popul Trends. 2010;100:32–9.
2. Bewley S, Davies M, Braude P. Which career first? BMJ. 2005;331:588–9.
3. Menken J, Trussell J, Larsen U. Age and infertility. Science. 1986;233:1389–94.
4. ESHRE Capri Workshop Group. Fertility and ageing. Hum Reprod Updat. 2005;11:261–76.
5. Devroey, P., Godoy, H., Smitz, J., Camus, M., Tournaye, H., Derde, M.P., Van Steirteghem, A., 1996. Female age predicts embryonic implantation after ICSI: a case-controlled study. Hum. Reprod.11, 1324–1327.
6. Hull, M.G., Fleming, C.F., Hughes, A.O., McDermott, A., 1996. The age-related decline in female fecundity: a quantitative controlled study of implanting capacity and survival of individual embryos after in-vitro fertilization. Fertil. Steril. 65, 783–790.
7. Marcus, S.F., Brinsden, P.R., 1996. In-vitro fertilization and embryo transfer in women aged 40 years and over. Hum. Reprod. Update 2, 459–468.
8. Magarelli C, Pearlstone C, Buyalos R. Discrimination between chronological and ovarian age in infertile women aged 35 years and older: predicting pregnancy using basal follicle stimulating hormone, age and number of ovulation induction/intra-uterine insemination cycles. Hum Reprod. 1996;11(6):1214–9.

9. Harris, I.D., Missmer, S.A., Hornstein, M.D., 2010. Poor success of gonadotropin-induced controlled ovarian hyperstimulation and intrauterine insemination for older women. Fertil. Steril. 94, 144–148.
10. Corsan G, Trias A, Trout S, Kemmann E. Ovulation induction combined with intrauterine insemination in women 40 years of age and older: is it worthwhile? Hum Reprod 1996;11:1109–12.
11. Tsafrir, A., Simon, A., Margalioth, E.J., Laufer, N., 2009. What should be the first-line treatment for unexplained infertility in women over 40 years of age-ovulation induction and IUI, or IVF? Reprod. Biomed. Online 19, 4334.
12. Tatone, C., Amicarelli, F., Carbone, M.C., Monteleone, P., Caserta, D., Marci, R., Artini, P.G., Piomboni, P., Focarelli, R., 2008. Cellular and molecular aspects of ovarian follicle ageing. Hum. Reprod. Update 14, 131–142.
13. Frederick, J.L., Denker, M.S., Rojas, A., Horta, I., Stone, S.C., Asch, R.H., Balmaceda, J.P., 1994. Is there a role for ovarian stimulation and intra-uterine insemination after age 40? Hum. Reprod. 9, 2284–2286.
14. Wiser A et al. Ovarian stimulation and intrauterine insemination in women aged 40 years or more. Reprod BioMed Online. 2012;24:170–3.
15. Human Fertilisation and Embryology Authority (HFEA). Fertility treatment in 2010: trends and figures. London: HFEA; 2010.
16. Tsafrir A, Simon A, Revel A, Reubinoff B, Lewin A, Laufer N. Retrospective analysis of 1217 IVF cycles in women aged 40 years and older. Reprod Biomed Online. 2007 Mar;14(3):348-55.