(Modified  from “Current Trends in IVF”,  Benson, M.R., Omnia CME Journal, Oct. 2011)

Seeking fertility treatments faster, especially in older patients, is an important trend.  The evidence is clear and overwhelming that success rates are directly correlated with maternal age as demonstrated by the SART 2009 statistics.  Also, patients may not want to spend the time, energy and money required of lesser treatments that have lower per cycle success rates than IVF.  Some patients may choose to go to IVF following failed clomiphene treatment or directly to IVF after their fertility workup to optimize their outcomes.  This has been demonstrated as a rational and cost-effective approach by the FASST trial (Fast Track and Standard Treatment Trial)–a randomized clinical trial comparing two groups of treatment regimens, one having  a “faster” approach.

The first treatment group had a more traditional approach:   following clomiphene/IUI (intrauterine insemination) treatment with gonadotropin/IUI, and then IVF. The second group had a more aggressive approach: clomiphene/IUI followed directly by IVF if no initial success.

The objective of FASTT was to determine the value of gonadotropin/IUI therapy in infertile women aged 21-39 years.

The main outcome measure was the time it took to establish a pregnancy that led to a live birth and it’s cost-effectiveness, defined as the ratio of the sum of all health insurance charges between randomization and delivery divided by the number of couples delivering at least one live-born baby.  In the FASTT trial, Richard Reindollar  demonstrated an increased rate of pregnancy  in the accelerated arm compared with the conventional arm. Median time to pregnancy was 8 and 11 months, respectively.  If couples move on to IVF, the per-cycle chance of pregnancy is greatly increased.

With IVF in women under 40, the average pregnancy rate is about 40% in the first attempt and higher in some clinics. For women ages 40-42, the success rate with IVF nationally is about 15%,  and 5% or less for women over the age of 42.

(Reindollar et al, Fertility and Sterility, Aug. 2010)