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Relationship of follicle numbers and estradiol levels to multiple implantation in 3,608 intrauterine insemination cycles

  • Richard P Dickey
    Correspondence
    Reprint requests: Richard P. Dickey, M.D., Ph.D., The Fertility Institute of New Orleans, 6020 Bullard Avenue, New Orleans, Louisiana 70128 (FAX: 504-246-9778)
    Affiliations
    The Fertility Institute of New Orleans, New Orleans, Louisiana, USA

    Section of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, The Fertility Institute of New Orleans, New Orleans, Louisiana, USA
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  • Steven N Taylor
    Affiliations
    The Fertility Institute of New Orleans, New Orleans, Louisiana, USA

    Section of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, The Fertility Institute of New Orleans, New Orleans, Louisiana, USA
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  • Peter Y Lu
    Affiliations
    The Fertility Institute of New Orleans, New Orleans, Louisiana, USA

    Section of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, The Fertility Institute of New Orleans, New Orleans, Louisiana, USA
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  • Belinda M Sartor
    Affiliations
    The Fertility Institute of New Orleans, New Orleans, Louisiana, USA

    Section of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, The Fertility Institute of New Orleans, New Orleans, Louisiana, USA
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  • Phillip H Rye
    Affiliations
    The Fertility Institute of New Orleans, New Orleans, Louisiana, USA

    Section of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, The Fertility Institute of New Orleans, New Orleans, Louisiana, USA
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  • Roman Pyrzak
    Affiliations
    The Fertility Institute of New Orleans, New Orleans, Louisiana, USA
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      Abstract

      Objective: To determine the relationship of follicle numbers and estradiol (E2) levels to multiple implantations in human menopausal gonadotropin (hMG) and clomiphene citrate (CC) cycles.
      Design: Fifteen-year prospective study.
      Setting: Private infertility clinic.
      Patient(s): Women who underwent 3608 cycles of husband or donor intrauterine insemination (IUI).
      Intervention(s): Ovulation induction (OI) with CC, hMG, or CC+hMG.
      Main Outcome Measure(s): Pregnancy and multiple implantations.
      Result(s): Triplet and higher-order implantations—but not twin implantations—were related to age, E2 levels, and number of follicles ≥12 mm and ≥15 mm, but not number of follicles ≥18 mm, in hMG and CC+hMG cycles. For patients less than 35 years old, three or more implantations tripled when six or more follicles were ≥12 mm, in CC, hMG, and CC+hMG cycles, and when E2 was ≥1000 pg mL in hMG and CC+hMG cycles. For patients 35 or older, pregnancy rates in hMG and CC+hMG cycles doubled when six or more follicles were ≥12 mm, or E2 levels were >1000 pg mL, whereas 3 or more implantations were not significantly increased.
      Conclusions: Withholding hCG or IUI in CC, hMG, and CC+hMG cycles when six or more follicles are ≥12 mm may reduce triplet and higher-order implantations by 67% without significantly reducing pregnancy rates for patients under 35 years of age.

      Keywords

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      References

        • Roest J
        • van Heusden A.M
        • Mous H
        • Zeilmaker G.H
        • Verhoeff A
        The ovarian response as a predictor for successful in vitro fertilization treatment after the age of 40 years.
        J Assist Reprod Technol. 1996; 66: 969-973
        • Deaton J.L
        • Gibson M
        • Blackmer K.M
        • Nakajima S.T
        • Badger G
        • Brumsted J.R
        A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis.
        Fertil Steril. 1990; 54: 1083-1088
        • Dickey R.P
        • Olar T.T
        • Taylor S.N
        • Curole D.N
        • Rye P.H
        • Matulich E.M
        Relationship of follicle number, serum estradiol, and other factors to birth rate and multiparity in human menopausal gonadotropin-induced intrauterine insemination cycles.
        Fertil Steril. 1991; 56: 89-92
        • Martinez A.R
        • Bernardus R.E
        • Voorhorst F.J
        • Vermeiden J.P.W
        • Schoemaker J
        Pregnancy rates after timed intercourse or intrauterine insemination after human menopausal gonadotropin stimulation of normal ovulatory cycles.
        Fertil Steril. 1991; 55: 258-265
        • Dickey R.P
        • Olar T.T
        • Taylor S.N
        • Curole D.N
        • Rye P.H
        Relationship of follicle number and other factors to fecundability and multiple pregnancies in clomiphene citrate induced intrauterine insemination cycles.
        Fertil Steril. 1992; 57: 613-619
        • Pittrof R.U
        • Shaker A
        • Dean N
        • Bekir J.S
        • Campbell S
        • Tan S.L
        Success of intrauterine insemination using cryopreserved donor sperm is related to the age of the woman and the number of preovulatory follicles.
        J Assist Reprod Genet. 1996; 13: 310-314
        • Tomlinson M.J
        • Amissah-Arthur J.B
        • Thompson K.A
        • Kasrale J.L
        • Bentick B
        Prognostic indicators for intrauterine insemination (IUI).
        Hum Reprod. 1996; 11: 1892-1896
        • Stone B.A
        • Vargyas J.M
        • Ringler G.E
        • Stein A.L
        • Marrs R.P
        Determinants of the outcome of intrauterine insemination.
        Am J Obstet Gynecol. 1999; 180: 1522-1534
        • Dodson W.C
        • Haney A.F
        Controlled ovarian hyperstimulation and intrauterine insemination for treatment of infertility.
        Fertil Steril. 1991; 55: 457-467
        • Haning R.V
        • Boehnlein L.M
        • Carlson I.H
        • Kuzma D.L
        • Zweibel W.J
        Diagnosis-specific serum 17B-estradiol (E2) upper limits for treatment with menotropins using a 125I direct E2 assay.
        Fertil Steril. 1984; 42: 882-889
        • Valbuena D
        • Simon C
        • Romero J.L
        • Remohi J
        • Pellicer A
        Factors responsible for multiple pregnancies after ovarian stimulation and intrauterine insemination with gonadotropins.
        J Assist Reprod Genet. 1996; 13: 663-668
        • Stone S.C
        • Schimberni M
        • Schuster P.A
        • Werlin L.B
        • Weathersbee P
        Incidence of multiple gestations in the presence of two or more mature follicles in the conception cycle.
        Fertil Steril. 1987; 48: 503-504
        • Navot D
        • Goldstein N
        • Mor-Josef S
        • Simon A
        • Relou A
        • Birkenfeld A
        Multiple pregnancies.
        Hum Reprod. 1991; 6: 1152-1155
        • Tal J
        • Paz B
        • Samberg I
        • Lazarov N
        • Sharf M
        Ultrasonographic and clinical correlates of menotropin versus sequential clomiphene citrate.
        Fertil Steril. 1985; 44: 342-349
        • Vollenhoven B
        • Selub M
        • Davidson O
        • Lefkow H
        • Henault M
        • Serpa N
        • Hund T.T
        Treating infertility.
        J Reprod Med. 1996; 41: 658-664
        • Fink R.S
        • Bowes L.P
        • Mackintosh C.E
        • Smith W.I
        • Georgiades E
        • Ginsburg J
        The value of ultrasound for monitoring responses to gonadotropin.
        Br J Obstet Gynaecol. 1982; 89: 856-861
        • Dodson W.C
        • Hughes C.L
        • Haney A.F
        Multiple pregnancies conceived with intrauterine insemination during superovulation.
        Am J Obstet Gynecol. 1988; 159: 382-385
        • Ben-Nun I
        • Cohen E
        • Shulman A
        • Fejgin M
        • Goldberger S
        • Beyth Y
        The inability of preovulatory ovarian scans to predict multifetal pregnancy occurrence in a follow-up of induction of ovulation with menotropins.
        Fertil Steril. 1993; 60: 781-785
        • Schenker J.G
        • Yarkoni S
        • Granat M
        Multiple pregnancies following induction of ovulation.
        Fertil Steril. 1981; 35: 105-123
        • Virro M.R
        • Shewchuk A.B
        Pregnancy outcome in 242 conceptions after artificial insemination with donor sperm and effects of maternal age on the prognosis for successful pregnancy.
        Am J Obstet Gynecol. 1984; 148: 518-532
        • Takokoro N
        • Vollenhoven B
        • Clark S
        • Baker G
        • Kovacs G
        • Burger H
        • Healy D
        Cumulative pregnancy rates in couples with anovulatory infertility compared with unexplained infertility in an ovulation induction programme.
        Hum Reprod. 1997; 12: 1939-1944
        • Yovich J.L
        • Matson P.L
        The treatment of infertility by the high intrauterine insemination of husband’s washed spermatozoa.
        Hum Reprod. 1988; 3: 939-943
        • Zikopoulos K
        • West C.P
        • Thong P.W
        • Kacser E.M
        • Morrison J
        • We F.C.W
        Homologous intrauterine insemination has no advantage over timed natural intercourse when used in combination with ovulation induction for the treatment of unexplained infertility.
        Hum Reprod. 1993; 8: 563-567
        • Hughes E.G
        • Collins J.A
        • Gunby J
        A randomized controlled trial of three low-dose gonadotropins protocols for unexplained infertility.
        Hum Reprod. 1998; 13: 1527-1531
        • Kemmann E
        • Bohrer M
        • Shelden R
        • Fiasconaro G
        • Beardsley L
        Active ovulation management increases the monthly probability of pregnancy occurrence in ovulatory women who receive intrauterine insemination.
        Fertil Steril. 1987; 48: 916-920
        • Remohi J
        • Gastaldi C
        • Patrizio P
        • Gerli S
        • Ord T
        • Asch R.H
        • Balmaceda J.P
        Intrauterine insemination and controlled ovarian hyperstimulation in cycles before GIFT.
        Hum Reprod. 1989; 4: 918-920
        • Dickey R.P
        • Pyrzak R
        • Lu P.Y
        • Taylor S.N
        • Rye P.H
        Comparison of sperm quality resulting in successful intrauterine insemination with world health organization criteria for normal sperm.
        Fertil Steril. 1999; 71: 684-689
        • Skaf R.A
        • Kemmann E
        Postcoital testing in women during menotropin therapy.
        Fertil Steril. 1982; 37: 514-519
        • Dickey R.P
        • Olar T.T
        • Taylor S.N
        • Curole D.N
        • Rye P.H
        Sequential clomiphene citrate and human menopausal gonadotropin for ovulation induction.
        Hum Reprod. 1993; 8: 56-59
        • Dickey R.P
        • Taylor S.N
        • Curole D.N
        • Rye P.H
        • Lu P.Y
        • Pyrzak R
        Relationship of clomiphene dose and patient weight to successful treatment.
        Hum Reprod. 1997; 12: 449-453
        • Silverberg K.M
        • Olive D.L
        • Burns W.N
        • Johnson J.V
        • Groff T.R
        • Schenken R.S
        Follicular size at the time of human chorionic gonadotropin administration predicts ovulation outcome in human menopausal gonadotropin-stimulated cycles.
        Fertil Steril. 1991; 56: 296-300
        • Corsan G
        • Trias A
        • Trout S
        • Kemmann E
        Ovulation induction combined with intrauterine insemination in women 40 years of age and older.
        Hum Reprod. 1996; 11: 1109-1112
        • Dickey R.P
        • Taylor S.N
        • Curole D.N
        • Rye P.H
        • Lu P.Y
        Ovulation induction and IUI in older women.
        Hum Reprod. 1997; 11: 199
        • Nitschke-Dabelstein S
        Monitoring of follicular development using ultrasonography.
        in: Insler V Lunenfeld B Infertility —male and female. Churchill-Livingstone, Edinburgh1983
        • Martin K
        • Santoro N
        • Hall J
        • Filicori M
        • Wierman M
        • Crowley C
        Management of Ovulatory Disorders with Pulsatile Gonadotropin-Releasing Hormone.
        J Clin Endocrinol Metab. 1990; 71: 1081A-1081G
        • Dickey R.P
        • Olar T.T
        • Curole D.N
        • Taylor S.N
        • Rye P.H
        • Matulich E.M
        The probability of multiple births when multiple gestational sacs or viable embryos are diagnosed at first trimester ultrasound.
        Hum Reprod. 1990; 5: 880-882