IVF or Insemination in Early 40s?

Aug. 9, 2002 -- A low-tech infertility treatment that costs thousands less than in vitro fertilization appears to be a reasonable treatment option for women in their early 40s who want to have a baby.

Women struggling with infertility in their 40s are often told that in vitro fertilization offers the best chance of conceiving with their own eggs. But research from Canada's University of Western Ontario suggests that intrauterine insemination (IUI) can also be effective for women in their early 40s. In vitro fertilization (IVF) can cost anywhere from $8,000 to $15,000 per treatment, while IUI costs a few hundred to a few thousand dollars.

IVF involves surgery to remove eggs from a woman's ovaries that have been stimulated with drugs to produce multiple eggs. The eggs are then mixed with sperm in the laboratory and fertilization hopefully takes place. With IUI, the sperm is injected through a thin flexible tube directly into the uterus.

The Canadian researchers reviewed the results of over 1,100 IUI procedures and found that the birth rate for women between the ages of 40 and 42 was 9.8% per procedure, compared to 12.9% for women of all ages. Older women did have significantly more miscarriages however, with 52% of women in their 40s losing the pregnancy, compared to 35% of women between the ages of 30 and 35. The findings were published in the July issue of the journal Fertility and Sterility.

"The overall success rate with IVF is about 15% for women who are in that 40 to 42-year age group, so many couples may feel that the difference doesn't justify the cost," fertility specialist Steven J. Ory, MD, tells WebMD. "But obviously neither procedure is very effective after 40. There is a dramatic decline in the success rate of all interventions with the exception of using donor eggs." Ory practices in Margate, Fla., and is president of the Society for Reproductive Endocrinology and Infertility.

Fertility specialist E. Scott Sills, who practices in Atlanta, Ga., says he does not believe women over 40 are being steered away from IUI to more expensive and high-tech infertility treatments. But he adds that most couples he sees would not consider a treatment with a success rate of less than 10% just because it is less expensive.

"In a patient over 40, the odds are against achieving pregnancy unless a donor egg is used, and these findings don't dispute that," he says. "But I don't disagree with the message that this treatment should be considered in women in their early 40s."

Ory and Sills agree that fertility specialists counseling older women have an obligation to explain the risks, benefits and potential success rates of all viable treatment options. Sills adds that older women over 40 must also consider their higher risk of delivering a child with genetic abnormalities. At age 45 the risk of having a child with Down syndrome is one in 35, compared to one in 2,000 for women under 35.

"The physician has a big responsibility to communicate the subtleties of the various options, but in the end it is the patient's decision," he says. "The decision should never be made unilaterally by the physician."