TY - JOUR
T1 - Do oral ovulation induction agents offer benefits in women 38 to 43 years of age undergoing insemination cycles?
AU - Steiner, Naama
AU - Ruiter-Ligeti, Jacob
AU - Frank, Russell
AU - Al Shatti, Maryam
AU - Badeghiesh, Ahmad
AU - Rotshenker-Olshinka, Keren
AU - Buckett, William
AU - Dahan, Michael H.
N1 - Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - 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.
AB - 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.
KW - Controlled ovarian hyperstimulation (COH)
KW - Infertility
KW - Intrauterine insemination (IUI)
KW - Older patients
UR - http://www.scopus.com/inward/record.url?scp=85099623838&partnerID=8YFLogxK
U2 - 10.1016/j.ejogrb.2021.01.012
DO - 10.1016/j.ejogrb.2021.01.012
M3 - Article
C2 - 33486239
AN - SCOPUS:85099623838
SN - 0301-2115
VL - 258
SP - 273
EP - 277
JO - European Journal of Obstetrics and Gynecology and Reproductive Biology
JF - European Journal of Obstetrics and Gynecology and Reproductive Biology
ER -