National survey of the current management of infertility in women aged 40 and over in the UK.

We conducted a national survey to identify the variation in the management of infertility in women aged 40 and over among the assisted conception units in the UK. A total of 44 out of 69 IVF units replied by filling in a questionnaire. Nearly half of the units (49%) offer treatment to this age group 6 months after trying for a pregnancy. As first-line management, 71.7% would offer conventional in vitro fertilisation (IVF) and 17.9% intrauterine insemination (IUI). On average, the doctors would move on from IUI to the next step after three attempts. The survey revealed a mean age of 45 as the upper limit for application of IVF (own eggs), and 43% of the units will recommend three cycles of IVF using own eggs before moving to egg donation. Among interventions to improve outcome, 33.3% would consider blastocyst transfer, 5.9% pre-implantation genetic screening (PGS) and 3.9% assisted zona hatching (AZH).