Controlled ovarian hyperstimulation interventions in infertile women aged 40 years or older undergoing in vitro fertilization

Background: The success of in vitro fertilization (IVF) treatment depends on adequate follicle recruitment following controlled ovarian hyperstimulation (COH). Women aged 40 years or older have a reduced ovarian reserve and various treatment protocols have been proposed that aim to increase their ovarian response. Objectives: To compare the effectiveness of different COH treatment interventions in women undergoing IVF aged 40 years or older. Search strategy: MEDLINE, the Cochrane Library, and the Chinese Biomedical database were searched for randomized controlled trials (RCTs). Selection criteria: Only RCTs comparing one type of COH intervention with another in women undergoing IVF aged 40 years or older were included. Data collection and analysis: Two authors independently searched the abstracts, identified relevant papers, assessed inclusion and trial quality, and extracted the relevant data. Main results: Four trials involving 4 different comparison groups were included in the review and enrolled a total of 611 randomized subjects. Conclusion: There was insufficient evidence to support the routine use of any particular COH intervention to manage infertile women aged 40 years or older undergoing IVF. More robust data from good quality RCTs with relevant Outcomes are needed. (C) 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.