Strategies to reduce multiple pregnancies due to ovulation stimulation
Received 5 August 2008; accepted 5 August 2008. published online 29 October 2008.
Objective
To review factors associated with high-order multiple births (HOMB) due to ovulation induction (OI) and the efficacy of strategies to reduce their occurrence.
Design
Retrospective analysis of published studies of OI with intrauterine insemination (IUI) where patient and cycle characteristics were fully documented.
Result(s)
High-order multiple pregnancies (HOMP) were positively related to use of high doses of gonadotropin, number of 7–10 mm preovulatory follicles, and E2, and inversely related to age and number of treatment cycles. Strategies successful in reducing HOMP include: use of clomiphene (CC) before gonadotropins, minimal gonadotropin doses, cancellation for more than three follicles >10–15 mm, and aspiration of excess follicles. Depending on the strategy used, 5%–20% of cycles may be canceled but HOMP rates can be less than 2% and pregnancy rates can average 10%–20% per cycle. Pregnancy rates per patient need not be reduced if low doses are continued for 4–6 cycles.
Conclusion(s)
High-order multiple pregnancies due to OI can be reduced to 2% or less by less aggressive stimulation without reducing overall chances of pregnancy for most patients.
Section of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, and The Fertility Institute of New Orleans, New Orleans, Louisiana
ABSTRACT