Do oral ovulation induction agents offer benefits in women 38 to 43 years of age undergoing insemination cycles?. (March 2021)

• Record Type: Journal Article
• Authors: Steiner, Naama; Ruiter-Ligeti, Jacob; Frank, Russell; Al Shatti, Maryam; Badeghiesh, Ahmad; Rotshenker-Olshinka, Keren; Buckett, William; Dahan, Michael H.
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 258(2021)
• Page Start: 273
• Page End: 277
• Publication Date: 2021-03
• Subjects: Controlled ovarian hyperstimulation (COH) -- Intrauterine insemination (IUI) -- Older patients -- Infertility; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2021.01.012
• Languages: English
• ISSNs: 0301-2115

Abstract

Abstract: Objective: To compare the success of ovulation induction using oral agents versus gonadotropins (GTs) in women ≥38 years old. Study Design: A retrospective cohort study was performed including all first to third stimulated IUI cycles conducted after the age of 38 years in a single academic fertility center between 01/2011 and 03/2018. Results: A total of 1596 IUI cycles were included. 240 cycles were with clomiphene citrate (CC), 176 letrozole cycles and 1180 gonadotropin (GTs) cycles. The GTs group were older (p < 0.001), had lower antral follicular count (p < 0.001), and thicker endometrium (p < 0.001) compared to the oral agent groups. The letrozole group had a less mature follicles (p = 0.004) at the time of triggering compared to the other groups. No difference in pregnancy or clinical pregnancy rates was observed after controlling for confounders when comparing the 3-groups. 5 multiple pregnancies occurred, all in the GTs group. The groups were subdivided by age; 38–39 years old (N = 750) and 40–43 years old (N = 846). Nevertheless, no statistical difference was observed in pregnancy rates and clinical pregnancy rates between oral agents and GTs when controlling for the confounding effects among women at age 38–39 (p = 0.47, p = 1.0; respectively) and among women 40–43-years-old (p = 0.16, p = 1.0; respectively). Conclusions: Clearly costs of oral agents are lower and they are more patient friendly than GTs, therefore oral agents should be first line for ovarian stimulation and IUI in women 38–43-years of age.