"Patients often ask why monthly conception rates are so low and should they continue to attempt to conceive if their chance is less than a 10% conception rate per menstrual cycle. The short answer is that a woman's fertility declines with age and that the cumulative effect of being exposed to sperm each month leads to approximately 45% of women conceiving after 12 months of periovulatory intercourse if they had a 5% chance of conceiving per cycle.

The chance of conceiving per month is called your monthly cycle fecundability rate. If you're a woman who is attempting to conceive with thawed donor sperm, the maximum cycle fecundability may only be 15% per spontaneous menstrual cycle. Unfortunately, women using donor sperm don't have the luxury of a free sperm source and they have to pay for each exposure to sperm through artificial insemination. Suboptimal treatment cycles are magnified when the cost of the sperm and an intrauterine insemination (IUI) exceeds a minimum of $400 per cycle in our center.

It is imperative that before you attempt to conceive your treating physician should assess 1) whether you're ovulating, 2) that your uterine cavity is free of any defects and 3) your fallopian tubes are patent.

If you have regular menstrual cycles (every 26-32 days) and don't have a history of a previous pelvic infection, you and your physician may decide to empirically inseminate you with donor sperm. There is a risk, however, of not detecting repetitive anovulatory cycles or blocked fallopian tubes before starting empiric insemination therapy. If this were the case, any associated medication used or insemination procedure would be considered "wasted" therapy.

Since fertility declines with age, if you're over 37 years of age you may need to consider starting with fertility medications to increase your chance of conceiving in any given menstrual cycle and shorten the time to pregnancy. Using injectible fertility medications may increase the cycle fecundability rate by 10% above your age-adjusted rate. For women under 35 years old, the conception rate might increase to 25% per menstrual cycle.

If you are between 37-40 years old, you may only have 15% chance of conceiving per cycle. The cost of this therapy will be approximately $2,000 per treatment cycle. One of the major risks of this therapy include an increased chance of a high-order multiple gestation (triplets or greater).

The best single-cycle conception rates are with in vitro fertilization (IVF), with conception rates of 50%, 35% and 22% for women less than 35, 35-39 and greater than 40 years old using donor sperm, respectively. The cost of therapy is approximately $10,000-$13,000 depending on a woman's response to the fertility medication. This may be the best option if a woman doesn't have a lot time to conceive with less successful therapies.

With any infertility treatment, the woman should discuss with her physician the number of investigative (diagnostic) studies to be performed before any actual therapy. The exact number of tests will vary with the patient’s prior medical history and the medical setting of the treating physician (access to the use of ultrasound, determination of hormone levels or office hysteroscopy). If you’re not satisfied with your therapy, seek a second opinion from another physician or discuss it with the doctor or the medical staff in the office."

Steven T. Nakajima, M.D.
Professor and Division Chief
Division of Reproductive Endocrinology and Infertility
Department of Obstetrics, Gynecology and Women’s Health
University of Louisville
Louisville, KY 40292