The ideal and most effective means to treat unexplained infertility in older women is uncertain. Most fertility specialists proceed in a step‐wise fashion from simpler to more complex (an expensive) treatments to see what works for the patient. Insurance companies often require this step‐wise approach since it limits expenses. The step‐wise approach can sometimes be detrimental, as delays for 6 to 12 months caused by ineffective treatments may increase the risk of failure in women in their early 40’s where “time is their enemy”.
A recent study of 154 women from age 38 to 43 with unexplained infertility showed that immediate treatment with IVF (and skipping fertility drugs with intrauterine insemination or IUI) gave a pregnancy rate 3X higher. This study performed at the Dartmouth Hitchcock Medical Center in New Hampshire by Dr. Richard Reindollar and colleagues, helps to clarify the best treatment for reproductively older women undergoing fertility treatments. Study participants had an equal chance of receiving either immediate IVF, clomiphene with IUI, or fertility shots with IUI. Women who had immediate IVF had a pregnancy rate of 24.7% after 2 cycles which was 3X higher than either treatment with clomiphene‐IUI or follicle‐stimulating hormone injections with IUI. Overall, IVF was responsible for over 70% of the babies born in these older women. Given the limited window of opportunity for older women with fertility problems, IVF appears to be the most likely treatment option that will result in the birth of a baby.