Ovarian stimulation and intrauterine insemination at the quarter centennial: implications for the multiple births epidemic

McClamrock, Howard D.; Jones, Howard W.; Adashi, Eli Y.

doi:10.1016/j.fertnstert.2012.02.031

Cited by 48 publications

(38 citation statements)

References 101 publications

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“…This finding is in line with previous evidence on hyperresponsivity of subfertile women, especially those with polycystic ovary syndrome (PCOS), to gonadotropins and its association with a greater frequency of multiple pregnancies. 1,15,18,25 Our finding of 31-fold increased risk of multiple births associated with invasive ART was comparable to findings from Zhu's et al 23 study who found a 29-fold and 33-fold increased risk of dizygotic twinning following IVF and intracytoplasmic sperm injection, respectively. These findings suggest a great contribution of multiple embryos transfer in ART cycles.…”

Section: Commentsupporting

confidence: 86%

See 1 more Smart Citation

Association between ovarian stimulators with or without intrauterine insemination, and assisted reproductive technologies on multiple births

Chaabane

Sheehy

Monnier

et al. 2015

American Journal of Obstetrics and Gynecology

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Section: Commentsupporting

confidence: 86%

“…1,2,10,17,18 However these studies were not designed to assess the risk of multiple births associated with those treatments.…”

Section: A N U S C R I P Tmentioning

confidence: 99%

Association between ovarian stimulators with or without intrauterine insemination, and assisted reproductive technologies on multiple births

Chaabane

Sheehy

Monnier

et al. 2015

American Journal of Obstetrics and Gynecology

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“…In a review, the twin PR and high-order multiple PR are 0–28.6 % and 0–9.3 % for high-dose GT/IUI, 0–29.3 % and 0 % for low-dose GT/IUI, and 0–12.5 % and 0–3.7 % for CC/IUI, respectively [11]. The rate of multiple gestations for GT/IUI is too high to be accepted currently in Japan.…”

Section: Discussionmentioning

confidence: 99%

Acceptable pregnancy rate of unstimulated intrauterine insemination: a retrospective analysis of 17,830 cycles

Honda

Tsutsumi²,

Komoda³

et al. 2014

Reprod Medicine & Biology

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PurposeTo evaluate the pregnancy rate (PR) of unstimulated intrauterine insemination (IUI).MethodsThis was a retrospective study in a private fertility clinic. Between 2004 and 2013, a total of 4,045 women underwent 17,830 cycles of unstimulated IUI. The etiologies of subfertility in the couples were unexplained (51 %), male factor (36 %), coital problems (9.5 %), and cervical factor (3.5 %).ResultsThe PRs/cycle, between the 1st and 9th trials, in women <35, 35–37, 38–40, 41–42, and >42 years of age were 8.2, 7.3, 5.5, 3.6, and 0.9 %, respectively. In 10,076 cycles in which the male partner had a total motile sperm count ≥5 million, the PRs in the respective age groups were 9.9, 8.6, 6.1, 4.8, and 1.2 %. The largest-sized reported PRs for clomiphene citrate (CC)/IUI in the respective age groups were 11.5, 9.2, 7.3 4.3, and 1.0 % (4,199 cycles in total, Dovey et al., FertilSteril, 2008;90:2281–2286). There were no significant differences in PRs between unstimulated IUI and CC/IUI.ConclusionPR for unstimulated IUI was similar to the reported PR for CC/IUI. Although this was a retrospective study without a control group, to reduce multiple pregnancy rate, we believe that unstimulated IUI is a reasonable treatment.

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“…The high cost and limited insurance coverage of IVF in all but a few locales in the United States make it an unattainable option for most infertile couples. 1 Empirical ovarian stimulation has been thought to promote childbearing by increasing the number of ova ovulated, as well as possibly by enhancing implantation, placentation, or both through hormonal effects on the endometrium. 2–4 However, empirical ovarian stimulation (with clomiphene or particularly with gonadotropin) is frequently complicated by the ovarian hyperstimulation syndrome and by multiple gestations, with an increased risk of preterm birth and associated neonatal morbidity and costs.…”

mentioning

confidence: 99%

Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility

et al. 2015

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BACKGROUND The standard therapy for women with unexplained infertility is gonadotropin or clomiphene citrate. Ovarian stimulation with letrozole has been proposed to reduce multiple gestations while maintaining live birth rates. METHODS We enrolled couples with unexplained infertility in a multicenter, randomized trial. Ovulatory women 18 to 40 years of age with at least one patent fallopian tube were randomly assigned to ovarian stimulation (up to four cycles) with gonadotropin (301 women), clomiphene (300), or letrozole (299). The primary outcome was the rate of multiple gestations among women with clinical pregnancies. RESULTS After treatment with gonadotropin, clomiphene, or letrozole, clinical pregnancies occurred in 35.5%, 28.3%, and 22.4% of cycles, and live birth in 32.2%, 23.3%, and 18.7%, respectively; pregnancy rates with letrozole were significantly lower than the rates with standard therapy (gonadotropin or clomiphene) (P = 0.003) or gonadotropin alone (P<0.001) but not with clomiphene alone (P = 0.10). Among ongoing pregnancies with fetal heart activity, the multiple gestation rate with letrozole (9 of 67 pregnancies, 13%) did not differ significantly from the rate with gonadotropin or clomiphene (42 of 192, 22%; P = 0.15) or clomiphene alone (8 of 85, 9%; P = 0.44) but was lower than the rate with gonadotropin alone (34 of 107, 32%; P = 0.006). All multiple gestations in the clomiphene and letrozole groups were twins, whereas gonadotropin treatment resulted in 24 twin and 10 triplet gestations. There were no significant differences among groups in the frequencies of congenital anomalies or major fetal and neonatal complications. CONCLUSIONS In women with unexplained infertility, ovarian stimulation with letrozole resulted in a significantly lower frequency of multiple gestation but also a lower frequency of live birth, as compared with gonadotropin but not as compared with clomiphene. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT01044862.)

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Ovarian stimulation and intrauterine insemination at the quarter centennial: implications for the multiple births epidemic

Cited by 48 publications

References 101 publications

Association between ovarian stimulators with or without intrauterine insemination, and assisted reproductive technologies on multiple births

Association between ovarian stimulators with or without intrauterine insemination, and assisted reproductive technologies on multiple births

Acceptable pregnancy rate of unstimulated intrauterine insemination: a retrospective analysis of 17,830 cycles

Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility

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