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Older Infertile Couples and In Vitro Fertilization

Other fertility treatments less likely to result in pregnancy, birth for women over 38, researchers say

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Within two cycles:

  • 49 percent of those who received IVF became pregnant and 31 percent gave birth.
  • 22 percent of those with oral medication became pregnant and 16 percent gave birth.
  • 17 percent of those given injectable medication became pregnant and 14 percent gave birth.

All couples that had not been successful in their first two cycles of any treatment used IVF in their subsequent treatment cycles. The couples in the immediate IVF group of the study ended up needing 36 percent fewer total cycles before conception than the couples who began with oral or injectable medication.

By the end of the treatment, 71 percent of all couples in the study had conceived a clinical pregnancy and 46 percent delivered at least one live-born baby. About 84 percent of all live births in the study came about as a result of IVF.

These findings should cause insurance officials to reconsider their refusal to cover IVF, given that pregnancy occurs more rapidly with IVF and with fewer complications, said Dr. Tomer Singer, a reproductive endocrinologist at Lenox Hill Hospital in New York City.

Singer noted that the oral and injectable medications work by hyperstimulating the ovaries, which often causes a woman to conceive twins or triplets. Those pregnancies tend to be more complicated and more costly.

"If insurance companies will realize they may save money by following this route of treatment, this will eventually be the way to go," Singer said. "We are covering standard insemination, and those patients are taking the risk of twins. That will cost us so much more than helping a couple achieve a healthy pregnancy with one embryo."

Based on their findings, the study's authors also recommend that middle-aged couples who are reluctant to use IVF off the bat should opt for oral fertility drugs over injectable fertility medications.

"With the older women, doctors sometimes skip clomiphene, thinking that the pregnancy rate is higher with FSH," Goldman said. "We didn't see any benefit of using FSH, where the cost is higher and there's an increased risk of multiple births compared with clomiphene."

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