Agarwal, S. K., & Buyalos, R. P. (1996). Clomiphene citrate with intrauterine insemination: is it effective therapy in women above the age of 35 years? Fertility and Sterility, 65(4), 759-763. https://doi.org/10.1016/s0015-0282(16)58210-7
Agarwal SK, Buyalos RP. Clomiphene citrate with intrauterine insemination: is it effective therapy in women above the age of 35 years? Fertil Steril. 1996;65(4):759-763. doi:10.1016/s0015-0282(16)58210-7
Agarwal, Sanjay K., and Richard P. Buyalos. "Clomiphene citrate with intrauterine insemination: is it effective therapy in women above the age of 35 years?" Fertility and Sterility, vol. 65, no. 4, 1996, pp. 759-763.
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Pregnancy rates with clomiphene and IUI fall after age 35
Pregnancy rates with clomiphene and IUI fell after age 35 in a case series of 290 women at a university fertility clinic. After four cycles, 26 out of 100 women aged 36 or older had become pregnant, against 51 out of 100 aged 35 or younger. Women who ovulated and women who did not had similar rates.
Pregnant after four cycles: Aged 35 or younger, 51 in 100; Aged 36 or older, 26 in 100. Source: Agarwal SK et al., 1996, PMID 8654635.Study at a glance, case series of 290 women: Clomiphene with IUI pregnancy rates fell after age 35. Source: Agarwal SK et al., 1996, PMID 8654635.
Key Findings
The series covered 664 cycles in 290 women aged 22 to 48 and produced 69 clinical pregnancies, 10.4% per treatment cycle. More than 85% occurred within four cycles.
After four cycles, cumulative pregnancy rates were 50% at ages 30 or younger, 40% at 31 to 35, 26% at 36 to 40 and 24% at 41 or older.
Cumulative pregnancy rates after four cycles were 26% for women 36 or older and 51% for women 35 or younger (P = 0.008).
Clinical pregnancy rates per cycle were 6.5% for women 36 or older and 14.7% for women 35 or younger (P < 0.0005).
Over six cycles, cumulative pregnancy rates were 37.7% with ovulatory and 37.0% with anovulatory infertility (P = 0.52). Clinical rates per cycle were 11.0% and 9.1% (P = 0.46).
Interpretation
The study is a case series from one university clinic, covering women treated between 1991 and 1994. The series had no comparison group without clomiphene and IUI, so the results describe outcomes by age and diagnosis. The outcomes were cumulative and clinical pregnancy rates, with clinical pregnancy defined by a heartbeat on ultrasound. Live births were not an outcome. Of the women, 90 had anovulatory infertility (no ovulation) and 200 had ovulatory infertility. The authors did not examine the male partner's age. They conclude that cycles of clomiphene with IUI usually should not continue beyond four.
RRM Context
The workup covered ovulation, semen, the tubes and luteal phase function. Couples with no abnormality were labeled unexplained. Restorative reproductive medicine reads that label as undiagnosed. The authors cite earlier work from their center. That work linked clomiphene at conventional doses with unfavorable cervical mucus in 48% to 60% of cycles in ovulating women. Cycle charting methods record cervical mucus as a fertility sign.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objectives
To evaluate the influence of female age on clomiphene citrate (CC) with IUI therapy and to compare the efficacy of this therapy between patients with ovulatory and anovulatory infertility.
Setting
A university fertility clinic.
Subjects
Six hundred sixty-four CC with IUI cycles from 290 women aged 22 to 48 years.
Main Outcome Measures
Cumulative and clinical pregnancy rates (PRs).
Results
Both cumulative and clinical PRs declined substantially in women > 35 years when compared with those < or = 35 years. In addition, no difference in these parameters was noted between patients with ovulatory and anovulatory infertility diagnoses. The vast majority of pregnancies occurred within the first four treatment cycles, irrespective of age or ovulatory versus anovulatory infertility diagnoses.
Conclusions
The age-related decline in clinical PR is most rapid beginning at the age of 35 years. For any given age group, CC with IUI therapy has similar cumulative and clinical PRs for both ovulatory and anovulatory infertility diagnoses. This therapy usually should not extend beyond four cycles. Couples should be counseled about the dramatic fall in PRs occurring beyond the age of 35 years.
Therapeutics › Ovulation Agents › Selective Estrogen Receptor Modulators · Longevity and Reproductive Aging › Age and Fertility › Age and Treatment Outcomes · Assisted Reproduction › Outcomes and Effectiveness › Outcomes by Diagnosis
Sanjay K. Agarwal, Richard P. Buyalos
S Agarwal, Rick Buyalos, Dick Buyalos, Rich Buyalos, R Buyalos
PMID 8654635 8654635 DOI 10.1016/s0015-0282(16)58210-7 10.1016/s0015-0282(16)58210-7 Agarwal et al. 1996, Agarwal 1996
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