The combination of COH (controlled ovarian hyperstimulation) and IUI has been a mainstay of infertility treatment for about 20-25 years. The idea is that if we cause multiple follicles to ovulate and place more sperm in the reproductive tract than would normally swim in on their own then we increase the efficiency of the cycle to produce a pregnancy.
COH/IUI was originally invented as a treatment for patients/couples who were waiting for the opportunity to have IVF. In the 80’s, IVF centers could not keep pace with demand. People actually had to wait their turn for an IVF cycle. (Click here for abstract from 1987.)
Despite 20+ years of experience, our profession still does not completely agree on how best to administer the treatment (which drugs, how many follicles, how to monitor, how many IUIs/cycle, etc). We also do not have consistent outcome data. Consequently. different physicians will quote different rates and believe different studies.
This study in interesting because Massachusetts mandates IVF coverage but they also require several IUI cycles first. (Harris ID, et. al., Poor success of gonadotropin-induced controlled ovarian hyperstimulation and intrauterine insemination for older women. Fertil Steril 2010 94:144-148.) These authors from the Harvard medical system report their experience with older women, 38-39 and 40+ years.[table “28” not found /]
As you see in the table, COH/IUI therapy is not very effective in older women and all the pregnancies occur in the first 2 cycles for women 38-39 and in the first cycle in women 40+ years old.
I believe that this confirms other studies that suggest that if we choose to try COH/IUI, we should limit cycles and particularly in women 38 and older to 1-2 cycles at most.