A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T)

作者：Goldman Marlene B^*; Thornton Kim L; Ryley David; Alper Michael M; Fung June L; Hornstein Mark D; Reindollar Richard H

来源：Fertility and Sterility, 2014, 101(6): 1574-U415.

DOI：10.1016/j.fertnstert.2014.03.012

• Advanced reproductive age
• clomiphene citrate
• controlled ovarian hyperstimulation
• follicle-stimulating hormone
• FORT-T Trial
• intrauterine insemination (IUI)
• in vitro fertilization
• unexplained infertility

Objective: To determine the optimal infertility therapy for women at the end of their reproductive potential.
Design: Randomized clinical trial.
Setting: Academic medical centers and private infertility center in a state with mandated insurance coverage.
Patient(s): Couples with >= 6 months of unexplained infertility; female partner aged 38- 42 years.
Intervention(s): Randomized to treatment with two cycles of clomiphene citrate (CC) and intrauterine insemination (IUI), follicle stimulating hormone (FSH)/IUI, or immediate IVF, followed by IVF if not pregnant.
Main Outcome Measure(s): Proportion with a clinically recognized pregnancy, number of treatment cycles, and time to conception after two treatment cycles and at the end of treatment.
Result(s): We randomized 154 couples to receive CC/IUI (N = 51), FSH/IUI (N = 52), or immediate IVF (N = 51); 140 (90.9%) couples initiated treatment. The cumulative clinical pregnancy rates per couple after the first two cycles of CC/IUI, FSH/IUI, or immediate IVF were 21.6%, 17.3%, and 49.0%, respectively. After all treatments, 110 (71.4%) of 154 couples had conceived a clinically recognized pregnancy, and 46.1% had delivered at least one live-born baby; 84.2% of all live-born infants resulting from treatment were achieved via IVF. There were 36% fewer treatment cycles in the IVF arm compared with either COH/IUI arm, and the couples conceived a pregnancy leading to a live birth after fewer treatment cycles.
Conclusion(s): A randomized controlled trial in older women with unexplained infertility to compare treatment initiated with two cycles of controlled ovarian hyperstimulation/IUI versus immediate IVF demonstrated superior pregnancy rates with fewer treatment cycles in the immediate IVF group.

• 出版日期2014-6