Reducing the Risk of High-Order Multiple Pregnancy after Ovarian Stimulation with Gonadotropins

Gleicher, Norbert; Oleske, Denise M.; Tur-Kaspa, Ilan; Vidali, Andrea; Karande, Vishvanath

doi:10.1056/nejm200007063430101

Cited by 235 publications

(123 citation statements)

References 14 publications

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“…21 If starting doses and incremental dose adjustments are not carefully titrated, ovulation induction or intra-uterine insemination protocols with gonadotrophins may lead to high rates of multifollicular growth. 22 Even with low-dose FSH stimulation, obese and insulin-resistant women with PCOS have a much greater tendency to develop a multifollicular response and, thus, a relatively high cycle cancellation rate in order to avoid hyperstimulation. 23 Balen and Jacobs 20 showed that, if a low-dose step-up regimen is used, it is necessary to decide on both the starting dose and the incremental dose, and starting doses ranging from 37.5 to 150 IU/day have been used.…”

Section: Ovarian Stimulation In Obese and Non-obese Pcosmentioning

confidence: 99%

Ovarian Stimulation in Obese and Non-Obese Polycystic Ovary Syndrome Using a Low-Dose Step-Up Regimen with Two Different Starting Doses of Recombinant Follicle-Stimulating Hormone

et al. 2008

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Sixty-seven infertile women with polycystic ovary syndrome (PCOS) were divided into two groups, obese and nonobese, according to their body mass index. Waist-to-hip ratio, insulin resistance, total testosterone and dehydroepiandrosterone sulphate levels were significantly elevated in obese, compared with non-obese, patients. Both groups were treated with a low-dose step-up protocol of recombinant follicle-stimulating hormone (rFSH) with a starting dose of 50 IU/day and, every third day, a 25-IU increase in the dose until the appropriate dose was achieved for each individual, up to a maximum of 175 IU/day. In the obese group only, repeat therapy commenced in the second ovulatory cycle in women who had not become pregnant, however a starting dose of 75 IU/day was then used, with incremental and maximum dose as before. The results of the starting dose of 75 IU/day rFSH were compared with the results of a 50 IU/day rFSH starting dose in the obese group. A starting dose of 50 IU/day rFSH in a low-dose step-up regimen was found to be effective, safe and welltolerated for inducing follicular development in non-obese infertile women with PCOS. However, for obese PCOS patients, a starting dose of 75 IU/day rFSH is recommended.

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Section: Ovarian Stimulation In Obese and Non-obese Pcosmentioning

confidence: 99%

Ovarian Stimulation in Obese and Non-Obese Polycystic Ovary Syndrome Using a Low-Dose Step-Up Regimen with Two Different Starting Doses of Recombinant Follicle-Stimulating Hormone

et al. 2008

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“…In a review of their clinical practice Gleicher et al (2000) reported on pregnancy after COH.IUI in 3137 completed cycles. They reported a 14% clinical intrauterine pregnancy rate of which 71% were singletons, 22% twins, 5% triplets, 2.3% quadruplets, 1.1% quintuplets and 2% sextuplets.…”

Section: Controlled Ovarian Hyperstimulation: Intrauterine Inseminatimentioning

confidence: 99%

Prevention of Multiple Pregnancy During Ovulation Induction

Hale

2003

Twin res.

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“…Studies have shown that super ovulation is associated with a twenty percent incidence of twin pregnancy and about ten percent incidence for higher order multiple pregnancy (10,11). Complications to both mother and foetuses are known to be significantly more with multiple pregnancies than singleton pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Intestinal schistosomiasis acquired in Cameroon: A case report.

2010

IJTM

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Objective: Spontaneous reduction resulting from missed abortion of one or more of the foetuses before the 12 th week of pregnancy could affect obstetrics outcome. This study sought to analyse pregnancy and foetal outcome following vanishing foetal event in multifoetal pregnancies conceived through assisted and non-assisted technology fertility treatment.Methods: A 5 year prospective observational study conducted In Ahmadu Bello University Teaching Hospital Zaria, 345 Aero medical Hospital Kaduna and Alba Clinics and Medical Centre Kaduna. Patients either conceived with clomiphene citrate enhanced fertility treatment or through assisted reproductive technology (ART) treatment. Results: Fifteen cases were managed, of which 9 (60%) were non-ART conceptions and 6 (40%) ART conceptions. The 9 non -ART pregnancies were all twins spontaneously reduced to singletons, while the 6 ART pregnancies comprised of 4 (66.7%) twins reduced to singleton. 1 (16.7%) triplet reduced to twin and 1 quintuplet (16.7%) reduced to quadruplet. Outcome of 13 pregnancies reduced to singleton was favourable with 1 (7.7%) infant death due to complications of congenital heart disease. Triplet pregnancy reduced to twin was complicated with severe hypertension in pregnancy and spontaneous abortion at 19 weeks while the patient with quintuplet pregnancy reduced to quadruplet delivered at 7 months preceded by preterm premature rupture of membrane; 3 neonatal deaths was recorded. Conclusion: Outcome of vanishing foetus syndrome in higher order multiple pregnancy was associated with poor foetal outcome, however this may be unrelated to spontaneous foetal reduction event but to effect of multiple foetuses on pregnancy and inadequacies of intensive care units in the developing world.

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Reducing the Risk of High-Order Multiple Pregnancy after Ovarian Stimulation with Gonadotropins

Abstract: Gonadotropin stimulation that is less intensive than is currently customary may reduce the incidence of high-order multiple pregnancy in infertile women, though only to a limited extent and at the expense of overall pregnancy rates.

Cited by 235 publications

References 14 publications

Ovarian Stimulation in Obese and Non-Obese Polycystic Ovary Syndrome Using a Low-Dose Step-Up Regimen with Two Different Starting Doses of Recombinant Follicle-Stimulating Hormone

Ovarian Stimulation in Obese and Non-Obese Polycystic Ovary Syndrome Using a Low-Dose Step-Up Regimen with Two Different Starting Doses of Recombinant Follicle-Stimulating Hormone

Prevention of Multiple Pregnancy During Ovulation Induction

Intestinal schistosomiasis acquired in Cameroon: A case report.

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