Clomiphene citrate with intrauterine insemination: Is it effective therapy in women above the age of 35 years

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 less than or equal to 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.