IS THERE A ROLE FOR OVARIAN STIMULATION AND INTRAUTERINE INSEMINATIONAFTER AGE-40

The objective of this study was to determine the conception rate in in fertile couples in which the female partner was greater than or equal to 40 years old and who had received ovarian stimulation treatment and intra-uterine insemination (IUI). It was a retrospective study of 77 patients who underwent a total of 210 treatment cycles. Protocols for ovulation induction included clomiphene citrate, human menopausal gona dotrophin (HMG) and clomiphene citrate plus HMG. Patients were monitor ed using transvaginal ultrasound, and two IUI were performed 24 and 48 h after the determination of urinary luteinizing hormone (LH) surge o r human chorionic gonadotrophin (HCG) injection. A total of 11 pregnan cies were reported, giving a pregnancy rate of 14% per patient and 5% per cycle. Eight spontaneous abortions occurred, giving a pregnancy wa stage of 73%. In a previous comparative analysis of 543 patients < 39 years old receiving IUI and identical protocols of ovarian stimulation , 141 pregnancies were achieved, giving a pregnancy rate of 21% per pa tient and 10% per cycle. The miscarriage rate in that group was 18%. T his report compares IUI results for women greater than or equal to 40 years with those obtained previously for younger women, and shows the very poor success rate in women > 40 years of age. This information wi ll be important in the proper counselling of this group of patients, a s well as indicating that a prompt recommendation for assisted reprodu ctive treatment should be made soon after the failure of a few attempt ed cycles of ovarian stimulation treatment and IUI.