In a recently published randomized controlled trial in the Fertility & Sterility journal,the authors concluded that in older women with unexplained infertility that go directly to IVF had superior pregnancy rates with fewer treatment cycles in comparison with treatment initiated with two cycles of controlled ovarian hyperstimulation/IUI.

Important differences in the clinical pregnancy rates per couple were observed after the first two cycles of treatment: 21.6%, 17.3%, and 49.0%, for IUI with Clomid, IUI with FSH, and immediate IVF, respectively. They also found a large difference in the time-to-pregnancy that was more than two times shorter in the immediate IVF group.

There are few trials performed in women of this age group. Therefore, this trial provides relevant information. Although in younger women we usually start with simple and non-expensive options (like IUI or timed intercourse), in older women we should go faster. We know that the time that we may waste doing some not so successful treatments could reduce the probability of success of those more effective treatments. Therefore, this is something that should be discussed with the patients. In women over 38, going faster to IVF seems to be a good option.