The typical approach to fertility treatment when the cause of infertility is unknown is to start with the least invasive treatment option first. If there is no pregnancy after following this line of therapy for a few months, the fertility specialist will likely suggest something a little more complex, with in-vitro fertilization (IVF) usually the last option on the list. The latest study on infertility and older women, however, suggests the most effective way to go is to choose IVF first.
The study — Forty and Over Treatment Trial (FORT-T) — finds that older women who do successfully achieve pregnancy by choosing IVF first do so in fewer cycles than women of the same age range who start with other options and work their way to IVF as a last resort. Marlene Goldman, the lead researcher for the study, is affiliated with the Geisel School of Medicine at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.
Goldman enlisted 154 couples for her study. To enroll, each couple met the following criteria:
- Normal intercourse for longer than 6 months had failed to result in a pregnancy
- Diagnosed with unexplained infertility
- The female partner was between 38 and 42 years of age
All couples in the study were seeking infertility treatment from academic medical centers or private fertility centers in a state where coverage for infertility treatments was part of the state’s healthcare insurance mandate.
The couples were divided into three groups according to the randomly selected method of infertility treatment assigned to them:
- 51 couples received two cycles of clomiphene citrate (CC) and intrauterine insemination (IUI)
- 52 couples received follicle-stimulating hormone (FSH) and IUI
- 51 couples received immediate IVF
If the first two groups of couples failed to achieve pregnancy after the first two cycles of study, they underwent IVF.
Pregnancy rates after the first round of two cycles of treatment were:
- 21.6% in the CC/IUI group
- 17.3% in the FSH/IUI group
- 49.0% in the immediate IVF group
By the end of the study, when all groups had advanced to IVF if other methods had failed:
- 71.4% (110 couples) had conceived a clinically recognized pregnancy
- 46.1% delivered at least one living baby
- 84.2% of all live-born babies were the result of IVF
- The couples getting immediate IVF achieved pregnancy in 36% fewer treatment cycles than the other two groups.
- In all couples, live birth was achieved in fewer cycles when IVF was used.
The Goldman research team found the rate of pregnancy was superior when IVF was used. The team finds that older women are more likely to give birth to live babies more quickly, with fewer cycles of treatment, when they choose IVF first instead of other treatment options.
Source: Goldman, Marlene B, ScD, et al. “A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T).” Fertility and Sterility. Elsevier Inc. Apr 29, 2014. Web. May 16, 2014.