Selection of a treatment method for women over 40 whose main limitiation in conceiving is their age can be difficult. If they are in the "unexplained infertility" group with open tubes, no significant gynecologic problems and a partner with normal sperm parameters the common choices are to try injectable fertility drugs (COH) with artificial insemination (IUI) or in vitro fertilization (IVF). A recent study in Fertility & Sterility compared groups of women aged 38-39 with a group over 40.
The women who were 38–39 years old had an overall live birth rate of 6.1% per cycle, with no live births occurring after the second cycle, and women over 40 years old had an overall live birth rate of 2.0% per cycle, with all births occurring in the first cycle. These data suggest that the efficacy of COH/IUI cycles significantly decreases with age, but women aged 38–39 years had reasonable success during the first two cycles. However, for women aged over 40 years, no benefit after a single cycle of COH/IUI was observed. Women over 40 years should be considered for in vitro fertilization as the first choice or after one failed COH/IUI cycle.