Should patients above 30 years old be advised to have treatments with Gonadotropins and Intra Uterine Insemination before switching to IVF?

Introduction: IUI with Gonadotropins(GT) is a common fertility treatment, in patients with unexplained infertility or mild male factor before switching to In-Vitro Fertilization (IVF). The advantage of IUI treatments prior to switching to IVF in women aged >39 has been reported low and women are advised to go directly to IVF. Although the practice of GT+IUI has been the standard of care , the UK NICE guidelines states that IUI is not beneficial in couples with unexplained infertility, a low sperm count or poor‑quality sperm.

Aim: To compare pregnancy rates in IUI and IVF in women aged over 30 using partner`s sperm and donor sperm.

Materials and Methods: Retrospective study in women aged>30. 307 IUI cycles with partner or donor sperm due to unexplained infertility or male factor and 589 IVF cycles at Carmel Medical Center in 2011-2013. IVF cycles included patients with an indication for IVF as the primary treatment and patients who had IVF after 3 failed IUI cycles. Female age, past pregnancies, indication for IUI, IVF treatment protocol, source of sperm concentration and motility, number and maturity of oocytes collected, fertilization rates, number of embryos transferred and clinical pregnancy rates were recorded and compared between all groups.

Results: 176 women who underwent 589 IVF cycles, resulted in 104 clinical pregnancies and 307 IUI cycles performed prior to IVF yielding 12 pregnancies. In any age above 30, outcomes with IVF were significantly higher than with IUI. The chances to conceive by IVF was 5.34 times higher compared with IUI. No significant difference was found between treatments using partner sperm in Unexplained or Male factor infertility compared to donor sperm.

Conclustions: Although treatment with GT+IUI prior to switching to IVF is a routine in fertility centers , our results are in line with the UK NICE guidelines demonstrating that IUI is not beneficial in couples with unexplained infertility or male factor at any age above 30 using partners’ or donor sperm.