title: In Vitro Fertilization Versus Mild Stimulation Intrauterine Insemination in Women Aged 40 and Older.
abstract: The objective of this study was to compare clinical pregnancy rates (PRs) and pregnancy outcomes (POs) in patients undergoing in vitro fertilization (IVF) and a specific controlled ovarian hyperstimulation (mild-stimulation or mini-stim) and intrauterine insemination (IUI) protocol in women older than 40.
  
  
  
  It is a retrospective chart review of 770 cycles of all women aged 40 and older who underwent a first cycle of either IVF or mini-stim IUI between the years 2007 and 2012 at a single infertility center.
  
  
  
  The PR in all women aged 40 and above was 12% (65/531) for IVF and 5% (13/239) for mini-stim IUI ( P = .004). When divided into age-groups, the PR of IVF at age 40 was superior to that at age 41 and above (15% vs 7%, P = .002), while the PR of mini-stim IUI remains similar (3% vs 7%, P = .307). When comparing the outcomes of the 2 treatments in the different age-groups, it showed that in women aged 40, IVF PR was superior to that of mini-stim IUI (15% vs 3%, P = .032); while in women aged 41 and above, IVF and mini-stim IUI have similar PR (7% vs 7%, P = .866). When POs were compared, the rate of live birth per cycle initiated was 9.2% for IVF versus 1.28% for mini-stim IUI ( P < .001).
  
  
  
  While IVF and mini-stim IUI were found to have similar PRs in women aged 41 and above, POs are significantly better in IVF. A larger study is required to clarify the above results.
authors.affiliation: 1 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Laurice
authors.initials: L
authors.lastname: Bou Nemer
authors.affiliation: 1 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA.|2 IVF Florida Reproductive Associates, Margate, FL, USA.
authors.forename: Vanessa N
authors.initials: VN
authors.lastname: Weitzman
authors.affiliation: 3 Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, FL, USA.
authors.forename: Kristopher L
authors.initials: KL
authors.lastname: Arheart
authors.affiliation: 1 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA.|2 IVF Florida Reproductive Associates, Margate, FL, USA.
authors.forename: Marcelo J
authors.initials: MJ
authors.lastname: Barrionuevo
authors.affiliation: 1 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA.|2 IVF Florida Reproductive Associates, Margate, FL, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Christie
authors.affiliation: 4 Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Mouhayar
authors.affiliation: 1 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA.|2 IVF Florida Reproductive Associates, Margate, FL, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Hoffman
authors.affiliation: 1 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA.|2 IVF Florida Reproductive Associates, Margate, FL, USA.
authors.forename: Wayne S
authors.initials: WS
authors.lastname: Maxson
authors.affiliation: 1 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA.|2 IVF Florida Reproductive Associates, Margate, FL, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Ory
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007315:Insemination, Artificial / Q000379:methods*; D008875:Middle Aged; D010062:Ovulation Induction; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: IUI; IVF; age 40; mild stimulation; pregnancy outcome; pregnancy rate