Which Treatment Is Best For Older Patients Undergoing Donor Insemination?
Clinicians are often called upon to recommend treatment options for patients who are interested in achieving successful pregnancy after 40 years of age. Patients attempting to conceive using donor sperm after 40 years of age face several obstacles. The most obvious issue is that age has significantly reduced the prospects for successful pregnancy even when ovarian reserve testing is found to be normal. Additionally, the use of frozen donor sperm is a disadvantage because the freezing process results in significant reduction in sperm motility. For patients undergoing intra-uterine insemination, the absolute number of motile sperm provided to the patient by the sperm bank is reduced as a result of typical commercial sperm bank practices of dividing a single ejaculate into several separate samples for sale to multiple patients. Considering that the barriers to successful live birth in this group of patients include age as well as reduction in the number of motile sperm, it is important to explore whether utilizing in-vitro fertilization with direct injection of sperm into the egg (IVF/ICSI) is the most effective approach to treatment.
Investigators looking at the question of which treatment is best have shown that both intra-uterine insemination and in-vitro fertilization with intra-cytoplasmic sperm injection are successful treatments for patients 40 year of age or older using donor sperm to achieve pregnancy. Three months of IVF (In-Vitro Fertilization) with ICSI (intra-cytoplasmic sperm injection) and six months of intra-uterine insemination achieved similar live birth rates. In addition, investigators found that most of the pregnancies in the IVF/ICSI treatment group occurred in the first treatment cycle. The authors of this study, De Brucker, et. al., note that the “time-to pregnancy” was just one month in the majority of IVF/ICSI treated patients, compared to six months in the intra-uterine insemination group. Since “time-to pregnancy” is important to older patients undergoing donor insemination, IVF/ICSI may be the best treatment.