Treatment effectiveness in women over 40 years of age

Although it should be well known that women in their 30s have declining fertility and that it becomes quite difficult to get pregnant naturally after 40, we see almost daily in the fertility clinic women who do not want to experience this and who want to get pregnant „as naturally as possible“. The truth is, however, that if they have not managed to achieve this through regular unprotected intercourse with a proven fertile partner over the last 1-2 years, it is unlikely that they will be able to achieve it with even the simplest therapeutic measures such as cycle monitoring with the triggering of ovulation. The fertility specialist’s recommendation to only „experimentally“ do a few insemination cycles—but better to do one IVF soon—is usually perceived as too radical.
Over the years, there have been numerous publications that have unequivocally proven that the „more radical therapy“ is by far the most promising.
The current work of Dr. Amir Wiser from Canada „Ovarian stimulation and intrauterine insemination”
In the study ”In women aged 40 years or more„, published in RBM Online 2012, there is indeed a weakness in that “only” 250 women were compared, but it still comes to exactly the same conclusion that women >40 should not waste unnecessary time with simple treatments.
Of the female patients treated with clomifene stimulation and insemination, no one became pregnant; however, one woman did become pregnant with injection stimulation. However, in the IVF group of female patients (124), 22.6% were successfully treated.
Even with a birth rate of only 13-16%, therefore, when planning treatment in the fertility center, it should be IVF decided much earlier, even if this means effort and high costs.
An explanation for the much higher efficiency IVF compared to „observation cycles“ and inseminations is that in women around 40, only about every 7th-8th egg cell actually has a normal chromosomal distribution. Since IVF stimulation causes several eggs to mature simultaneously, the probability is high that at least one „good“ egg is present and can be fertilized.