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A comparison of oral versus injectable ovarian stimulation in IUI in women ≥38 years of age with decreased ovarian reserve

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare pregnancy rates of oral ovarian hyperstimulation agents (clomiphene citrate (CC) and letrozole) versus injectable agents (gonadotropins) in intrauterine insemination (IUI) in the older reproductive age group with diminished ovarian reserve.

Methods

A retrospective cohort study was performed among 210 women 38–43 years of age undergoing IUI with controlled ovarian hyperstimulation (COH) at a single academic institution between 2009 and 2018.

Results

A total of 335 IUI cycles met inclusion criteria. Gonadotropins were the most frequently used ovarian hyperstimulation agent (n = 264), followed by CC (n = 38) and letrozole (n = 33). Mean age of the cohort was 40.5 (±1.6) years (range 38–43) did not differ significantly among groups (p = 0.41). Mean AFC and number of mature follicles on day of ovulation trigger also did not differ among groups (p = 0.98, p = 0.10). Overall clinical pregnancy rate was 7.5% per cycle, and rates for CC, letrozole, and gonadotropins respectively were 5.3%, 9.1%, 7.5% per cycle (p = 0.347). There was one multiple gestation pregnancy (twins), which was in a patient stimulated with gonadotropins.

Conclusion

This is the first study to compare CC, letrozole, and gonadotropins in older reproductive age women with decreased ovarian reserve. The findings reveal that COH/IUI in older women with decreased ovarian reserve is a viable option (clinical pregnancy rate of 7.5% per cycle), and suggest that oral stimulation agents may be the first-line option, with letrozole having conferred the highest clinical pregnancy rate, 9.1%, which is notable given the typical poor fecundability of this population. However, larger population studies are needed to support this.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, McGill University Health Centre, McGill University, Montreal, QC, Canada

    Russell Frank, Naama Steiner, Maryam Al Shatti, Jacob Ruiter-Ligeti & Michael H. Dahan

Authors
  1. Russell Frank
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  2. Naama Steiner
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  3. Maryam Al Shatti
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  4. Jacob Ruiter-Ligeti
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  5. Michael H. Dahan
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Contributions

All authors contributed to the study conception and design. R. Frank: data collection, literature review, data analysis, interpretation of results, writing of manuscript. N Steiner: data collection, review of manuscript. M Al Shatti: data collection, review of manuscript. J Ruiter-Ligeti: project development, data collection, review of manuscript. M. H. Dahan: Project development, data analysis, review and editing of manuscript drafts

Corresponding author

Correspondence to Russell Frank.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes. The Intuitional Review Board reference is 2019-5254 (McGill University Health Centre). This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Frank, R., Steiner, N., Al Shatti, M. et al. A comparison of oral versus injectable ovarian stimulation in IUI in women ≥38 years of age with decreased ovarian reserve. Arch Gynecol Obstet 303, 1607–1616 (2021). https://doi.org/10.1007/s00404-020-05897-5

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  • DOI: https://doi.org/10.1007/s00404-020-05897-5

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