Be Aggressive, Be Be Aggressive!

Study shows that, for older couples, IVF may be the best starting point


I remember this common cheer from high school sports games. As it turns out, this cheer likely applies to older couples seeking fertility care (as well as high school athletes!). A recent study published in Fertility and Sterility examined the best treatment for older couples with unexplained infertility.

In the study, the female partner was between 38 and 42 years old, the couples had been attempting conception for at least six months without success, and the fertility evaluation for both partners revealed no identifiable cause for infertility. The couples were assigned to one of two groups; one received either oral or injectable medication with intra-uterine insemination (IUI) for two cycles followed by in vitro fertilization (IVF) if not pregnant, and the other group received immediate treatment with IVF for two treatment cycles.

After the first two treatment cycles, approximately 14 percent of the medication and IUI couples delivered a baby, versus approximately 31 percent of the IVF-only couples. At completion of the study after all remaining couples underwent IVF, the live birth rate was similar between all treatment groups (about 46 percent of the couples had a baby regardless of treatment type).

Nearly half of all the couples had a baby in the study despite their initial treatment assignment. But it is important to note that 84 percent of the babies born were conceived with IVF, whereas only 16 percent of the babies born were conceived with a less aggressive therapy. Additionally, the couples who were assigned to IVF only underwent a third of the number of treatment cycles compared to the other couples (meaning they had a successful pregnancy faster than the couples initially treated with medication and IUI).

Many couples are hesitant to jump right into IVF secondary to commitment and cost. Beginning with less aggressive, less invasive and less expensive treatments is a great starting point for a lot of couples and completely in line with our treatment philosophy at CU Advanced Reproductive Medicine. However, this study gives older couples important new information, suggesting that their time (and money) may be best spent on IVF when the goal is getting pregnant and having a baby as soon as possible.