Skip to main content
SpringerLink
Log in

Is intrauterine insemination a viable treatment option for women over 43 years old? An analysis by ovarian stimulation protocol and sperm source

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to determine how female age at the end of the reproductive spectrum effects success of natural cycle intrauterine insemination (IUI) or IUI in combination with ovarian stimulation.

Methods

We performed a retrospective cohort study of women 43 years of age and older at the time of IUI in a single academic fertility center between January 2011 and March 2018. Primary outcomes were both pregnancies and live births per cycle of IUI. Data are presented as percentage or mean ± SD. Fisher exact and chi-squared analyses were performed.

Results

There were 9334 IUI cycles conducted during the study period. Of these cycles, 325 IUIs (3.5%) were for women aged 43 years and over at the time of insemination (43.6 ± 0.8, range 43 to 47 years). Analysis of these 325 IUI cycles revealed 5 biochemical pregnancies (1.5%) and only 1 live birth (0.3%). The pregnancy rate did not differ between IUIs using donor sperm (N = 1/49, 2.0%) compared to IUIs with partner sperm (N = 4/276, 1.4%). The pregnancy rate did not differ between IUIs with gonadotropins (N = 2/211, 0.9%), clomiphene or letrozole (N = 2/78, 2.6%), or natural cycle (N = 1/36, 2.8%).

Conclusions

The use of intrauterine inseminations in women 43 years of age and older is an ineffective treatment strategy. This is irrespective of the use of ovarian stimulation or donor sperm. Costly gonadotropin injections did not increase the chance of pregnancy nor did oral medication when compared to natural cycle IUIs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mathews TJ HB. Delayed childbearing: more women are having their first child later in life. NCHS data brief, no 21. p. 1–8. 2009.

  2. ART Success Rates | CDC. [cited 2020 Apr 15]. Available from: https://www.cdc.gov/art/artdata/index.html

  3. Milan A. Fertility: Fewer children, older moms. Stat Canada. 2014 [cited 2020 Apr 15];630–X. Available from: https://www150.statcan.gc.ca/n1/pub/11-630-x/11-630-x2014002-eng.htm

  4. Khandwala YS, Zhang CA, Lu YEM. The age of fathers in the USA is rising: an analysis of 168 867 480 births from 1972 to 2015 - PubMed. Hum Reprod. 2017;32(10):2110–6.

    Article  Google Scholar 

  5. Mathews TJ HB. First births to older women continue to rise - PubMed. NCHS Data Brief, p. 152:1–8. 2014. https//www.cdc.gov/nchs/products/databriefs.htm.

  6. Provencher C, Milan A, Hallman S, Carol D. Fertility: overview, 2012 to 2016. Stat Canada. 2018. Available from: https://www150.statcan.gc.ca/n1/pub/91-209-x/2018001/article/54956-eng.htm

  7. Maheshwari A, Porter M, Shetty A, Bhattacharya S. Women’s awareness and perceptions of delay in childbearing. Fertil Steril. 2008;90:1036–42.

    Article  Google Scholar 

  8. Wyndham N, Marin Figueira PG, Patrizio P. A persistent misperception: assisted reproductive technology can reverse the “aged biological clock”. Fertil Steril. 2012;97:1044–7.

    Article  Google Scholar 

  9. Mac Dougall K, Beyene YNR. Age shock: misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40. Hum Reprod. 2013;28:350–6.

    Article  CAS  Google Scholar 

  10. Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF. Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. Hum Reprod. Oxford University Press. 1992;7:1342–6.

    Article  CAS  Google Scholar 

  11. Haebe J, Martin J, Tekepety F, Tummon I, Shepherd K. Success of intrauterine insemination in women aged 40-42 years. Fertil Steril. 2002;78:29–33.

    Article  Google Scholar 

  12. Belloc S, Cohen-Bacrie P, Benkhalifa M, Cohen-Bacrie M, de Mouzon J, Hazout A, et al. Effect of maternal and paternal age on pregnancy and miscarriage rates after intrauterine insemination. Reprod Biomed Online. Reproductive Healthcare Ltd. 2008;17:392–7.

    Article  Google Scholar 

  13. Schorsch M, Gomez R, Hahn T, Hoelscher-Obermaier J, Seufert R, Skala C. Success rate of inseminations dependent on maternal age? An analysis of 4246 insemination cycles. Geburtshilfe Frauenheilkd. 2013;73:808–11.

    Article  CAS  Google Scholar 

  14. Vichinsartvichai P, Siriphadung S, Traipak K, Promrungrueng P, Manolertthewan C, Ratchanon S. The influence of women age and successfulness of intrauterine insemination (IUI) cycles. J Med Assoc Thai. 2015 [cited 2020 Apr 16];98:833–8.

  15. Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020;113(2):305–22.

    Article  Google Scholar 

  16. Goldman MB, Thornton KL, Ryley D, et al. A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T). Fertil Steril. 2014;101(6):1574–81.e812.

    Article  Google Scholar 

  17. Schwartz D, Mayaux MJ. Female fecundity as a function of age: results of artificial insemination in 2193 nulliparous women with azoospermic husbands. N Engl J Med. 1982;306:404–6.

    Article  CAS  Google Scholar 

  18. Frederick JL, Denker MS, Rojas A, Horta I, Stone SC, Asch RH, et al. Infertility: is there a role for ovarian stimulation and intra-uterine insemination after age 40? Hum Reprod Oxford University Press. 1994;9:2284–6.

    Article  CAS  Google Scholar 

  19. Legro RS, Shackleford DP, Moessner JM, Gnatuk CL, Dodson WC. ART in women 40 and over. Is the cost worth it? J Reprod Med. 1997 [cited 2020 Apr 16];42:76–82. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9058341.

  20. Van Der Westerlaken LA, Naaktgeboren N, Helmerhorst FM. Evaluation of pregnancy rates after intrauterine insemination according to indication, age, and sperm parameters. J Assist Reprod Genet. 1998;15:359–64.

    Article  Google Scholar 

  21. Sahakyan M, Harlow BL, Hornstein MD. Influence of age, diagnosis, and cycle number on pregnancy rates with gonadotropin-induced controlled ovarian hyperstimulation and intrauterine insemination. Fertil Steril. 1999;72:500–4.

    Article  CAS  Google Scholar 

  22. 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. Oxford University Press. 1996;11:1109–12.

    Article  CAS  Google Scholar 

  23. Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, et al. Letrozole, gonadotropin, or clomiphene for unexplained infertility. N Engl J Med. 2015;373(13):1230–40.

    Article  CAS  Google Scholar 

  24. Evans MB, Stentz NC, Richter KS, Schexnayder B, Connell M, Healy MW, et al. Mature follicle count and multiple gestation risk based on patient age in intrauterine insemination cycles with ovarian stimulation. Obstet Gynecol. 2020;135(5):1005–14.

    Article  CAS  Google Scholar 

  25. Van Voorhis BJ, Sparks AET, Allen BD, Stovall DW, Syrop CH, Chapler FK. Cost-effectiveness of infertility treatments: a cohort study. Fertil Steril. Elsevier Inc. 1997;67:830–6.

    Article  Google Scholar 

  26. Goverde AJ, McDonnell J, Vermeiden JPW, Schats R, Rutten FFH, Schoemaker J. Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet Elsevier Limited. 2000;355:13–8.

    Article  CAS  Google Scholar 

  27. Daar J, Benward J, Collins L, Davis J, Davis O, Francis L, et al. Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion. Fertil Steril. Elsevier Inc. 2019;111:659–63.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, MUHC Reproductive Center, McGill University, 888, Blvd. de Maisonneuve East, Suite 200, Montreal, QC, H2L 4S8, Canada

    Jacob Ruiter-Ligeti, Michael H. Dahan, Naama Steiner, Alexander Volodarsky-Perel & William Buckett

Authors
  1. Jacob Ruiter-Ligeti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael H. Dahan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naama Steiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander Volodarsky-Perel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William Buckett
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacob Ruiter-Ligeti.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key messages

The use of intrauterine inseminations in women 43 years of age and older is an ineffective treatment strategy. This is irrespective of the use of ovarian stimulation or donor sperm.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ruiter-Ligeti, J., Dahan, M.H., Steiner, N. et al. Is intrauterine insemination a viable treatment option for women over 43 years old? An analysis by ovarian stimulation protocol and sperm source. J Assist Reprod Genet 37, 3103–3107 (2020). https://doi.org/10.1007/s10815-020-01976-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-020-01976-3

Keywords

Search

Navigation