Mature Follicle Count and Multiple Gestation Risk Based on Patient Age in Intrauterine Insemination Cycles With Ovarian Stimulation

Abstract

OBJECTIVE: To estimate the risk of a multiple gestation pregnancy in ovarian stimulation intrauterine insemination (IUI) cycles when stratified by patient age and mature follicle number. METHODS: We conducted a retrospective cohort study at a single private practice fertility center of IUI cycles performed from 2004 to 2017. Intervention(s) were ovarian stimulation and IUI if postwash total motile sperm count was more than 8 million. Mature follicles were defined as 14 mm or more as measured on the day of ovulation trigger. Main outcomes and measures were rates of clinical pregnancy and multiple gestation. RESULTS: We identified 24,649 women who underwent a total of 50,473 IUI cycles. Increasing the number of mature follicles from one to five at the time of IUI in women younger than age 38 years increased the clinical pregnancy rate from 14.6% to 21.9% (adjusted odds ratio [aOR] 1.6, 95% CI 1.4–1.9), almost entirely from a marked increase in multiple gestations per cycle from 0.6% to 6.5% (aOR 9.9, 95% CI 6.9–14.2). There was little increase in singleton pregnancies per IUI (14.1–16.4%) regardless of mature follicle number. The per-pregnancy twin and higher-order multiple gestation risk significantly increased (3.9–23.3%, P<.01 and 0.2–10.6%, P<.01, respectively) when comparing one with five mature follicles present at the time of IUI (P<.01). In women younger than age 38 years with more than three follicles present, more than one quarter of all pregnancies were multiples. Similar findings occurred in women aged 38–40 years. In women older than age 40 years, up to four follicles tripled the odds of pregnancy (aOR 3.1, 95% CI 2.1–4.5) while maintaining a less than 12% risk of multiple gestation per pregnancy and a 1.0% absolute risk of multiples. CONCLUSION: Caution should be used in proceeding with IUI after ovarian stimulation when there are more than two mature follicles in women younger than age 40 years owing to the substantially increased risk of multiple gestation without an improved chance of singleton clinical pregnancy.

Controlled ovarian stimulation should not be preferred for male infertility treated with intrauterine insemination: a retrospective study

“…Additionally, Evans et al [ 24 ] also reported that the mean clinical pregnancy rate per IUI ranged from 13.0% with one mature follicle to 19.6% with five mature follicles. The pregnancy rate increased modestly with the presence of each additional mature follicle (adjusted odds ratio: two follicles vs. one: 1.3, 95% CI 1.2–1.4; three follicles vs. one: 1.4, 95% CI 1.3–1.5; four follicles vs. one: 1.5, 95% CI 1.4–1.7; and five follicles vs. one: 1.6, 95% CI 1.4–1.9).…”

BCL-6 Overexpression as a Predictor for Endometriosis in Patients Undergoing In Vitro Fertilization

“… 3 , 14 According to 2017 Society for Assisted Reproductive Technology data, only 2.5% of IVF cycles are performed in patients diagnosed with endometriosis, leading us to believe that endometriosis is grossly underdiagnosed in the setting of infertility. 15 , 16 …”

Clomiphene Citrate versus Recombinant FSH in intrauterine insemination cycles with mono- or bi-follicular development

“…Although non-significant, the CPR was higher in multi-follicular development than mono-follicular development in both CC-IUI and rFSH-IUI cycles (Berker et al, 2011). Evans et al (2020) defined the mature follicles as a follicle size above 14 mm, and they found increasing pregnancy rates with increased number of mature follicles. Moreover, they showed higher multiple gestations with this increase.…”

“…However, the follicle sizes on the day of hCG were not homogeneous (van Rumste et al, 2008). Evans et al (2020) recently concluded that two preovulatory follicles improved the pregnancy rates, but more than two follicles did not contribute the chance of singleton pregnancy. We excluded the cycles that had more than two preovulatory follicles (>17 mm) and found that bi-follicular growth significantly increased the clinical pregnancy rate.…”