Risk factors for high-order multiple implantation after ovarian stimulation with gonadotrophins: evidence from a large series of 1878 consecutive pregnancies in a single centre

Tur, Rosa; Barri, Pedro N.; Coroleu, Buenaventura; Buxaderas, Rosario; Martínez, Francisca; Balasch, Juan

doi:10.1093/humrep/16.10.2124

Cited by 116 publications

(88 citation statements)

References 37 publications

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“…A recent study of maternity units undertaken in the UK found this figure to be 22%, and that 5% of all non-ART multiple deliveries were as a result of non-ART fertility treatment (Bardis et al, 2005). Furthermore, whereas HOM births resulting from ART treatment continue to decline with the trend to transferring fewer embryos, non-ART fertility treatment continues to contribute to an unacceptable number of HOMs pregnancies (CDC, 2000;Tur et al, 2001). The reduction of multiple births by close monitoring of follicular development and a conservative threshold for withholding treatment in non-ART fertility treatment will further reduce the perinatal morbidity and healthcare costs associated with fertility treatment.…”

Section: Discussionmentioning

confidence: 99%

Babies born after ART treatment cost more than non-ART babies: a cost analysis of inpatient birth-admission costs of singleton and multiple gestation pregnancies

et al. 2007

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BACKGROUND: Currently, about one-third of infants born after assisted reproductive technology (ART) worldwide are twins or triplets. This study compared the inpatient birth-admission costs of singleton and multiple gestation ART deliveries to non-ART deliveries. METHODS: A cohort of 5005 mothers and 5886 infants conceived following ART treatment were compared to 245 249 mothers and 248 539 infants in the general population. Birth-admission costs were calculated using Australian Refined Diagnosis Related Groups and weighted national average costs (2003-2004 euro). RESULTS: ART infants were 4.4 times more likely to be low birthweight (LBW) compared with non-ART infants, translating into 89% higher birth-admission costs (E2832 and E1502, respectively). ART singletons were also more likely to be LBW compared with non-ART singletons, translating into 31% higher birth-admission costs (E1849 and E1415, respectively). After combining infant and maternal admission costs, the average cost of an ART singleton delivery was E4818 compared with E13 890 for ART twins and E54 294 for ART higher order multiples. Findings were not sensitive to changes in casemix. CONCLUSIONS: The poorer neonatal outcomes of ART singletons compared with non-ART singletons are significant enough to impact healthcare resource consumption. The high costs associated with ART multiple births add to the overwhelming clinical and economic evidence in support of single embryo transfer.

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Section: Discussionmentioning

confidence: 99%

Babies born after ART treatment cost more than non-ART babies: a cost analysis of inpatient birth-admission costs of singleton and multiple gestation pregnancies

et al. 2007

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Section: Discussionmentioning

confidence: 99%

“…During ovarian stimulation (ovulation induction or ovarian hyperstimulation) it has been shown that the number of follicles measuring 12 mm or more at the day of hCG administration is strongly correlated with the incidence of high order multiple pregnancies (37,38). Similarly, E 2 serum concentrations are strongly correlated with adverse outcome (38). Since mid follicular inhibin B serum concentrations were correlated both with the number of follicles measuring 10 mm or more as well as with multi-follicular development, inhibin B might also constitute a predictor of multiple gestation during ovarian hyperstimulation.…”

Section: Discussionmentioning

confidence: 99%

Relationship between inhibin A and B, estradiol and follicle growth dynamics during ovarian stimulation in normo-ovulatory women

Laven¹,

Jong²,

Fauser³

2005

eur j endocrinol

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Objective: To investigate the relationship between serum concentrations of inhibin A, inhibin B and estradiol (E 2 ) and the number of developing follicles during the administration of exogenous follicle-stimulating hormone (FSH) in various regimens in normo-ovulatory volunteers and to evaluate if inhibins act as suitable markers for the number of developing follicles during ovarian stimulation. Design and methods: Serial hormone determinations and assessment of follicle numbers were carried out during unstimulated cycles and during various interventions with exogenous FSH. Subjects were randomized for FSH administration into the following groups: a single high dose (375 IU) during the early follicular phase (group A), 5 consecutive low doses (75 IU/day) starting in the mid follicular phase (group B) or daily low doses (75 IU/day) during the early to late follicular phase (starting on cycle days 3, 5 or 7; groups C, D and E respectively). Results: Extending the FSH window increases the number of small antral follicles and hence inhibin B serum concentrations. If such an intervention results in multi-follicular growth, mid follicular phase inhibin B (P ¼ 0.001) as well as late follicular phase inhibin B and inhibin A levels are significantly (P , 0.05 and P , 0.01 respectively) increased compared with mono-follicular cycles or the natural cycle. Although mid follicular inhibin B levels correlated well with the number of small antral (P , 0.05) and pre-ovulatory (P , 0.001) follicles in the late follicular phase, mid follicular inhibin A and estradiol serum concentrations only correlated with the number of pre-ovulatory follicles (P , 0.001 and P , 0.01 respectively). Conclusions: The present data extend our understanding of the relationship between follicle dynamics, serum inhibins and FSH during ovarian hyperstimulation. However, although mid follicular inhibin B does correlate with the number of developing follicles, it does not facilitate the identification of women at risk for multiple follicle development.European Journal of Endocrinology 152 395-401

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“…The value of cycle monitoring in MOH/IUI cycles has recently been the subject of a discussion in Fertility and Sterility [21] . Several large retrospective trials haven been published on this subject [22][23][24][25] . Although these trials were clinically heterogeneous, the probability of achieving a multiple pregnancy seemed to be related to the age of the woman, the total number of follicles, and/or the number of follicles 1 11 mm at the time of human chorionic gonadotropin administration.…”

Section: Can We Prevent Multiple Pregnancies After Moh/iui?mentioning

confidence: 99%

Should We Continue Performing Intrauterine Inseminations in the Year 2004?

Cohlen

2005

Gynecol Obstet Invest

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This review summarizes the existing evidence regarding intrauterine insemination (IUI) as a treatment for cervical hostility, male and unexplained subfertility. IUI in natural cycles has been proven effective in patients with cervical hostility and moderate male subfertility. IUI in cycles with mild ovarian hyperstimulation (MOH) should be the treatment of choice in couples with mild male subfertilty (average total motile sperm count above 10 million) and unexplained subfertilty. When MOH is applied, gonadotropins have been proven more effective compared with clomiphene citrate. Further large trials comparing clomiphene citrate with gonadotropins are mandatory. Prevention of multiple pregnancies in MOH/IUI programs is of paramount importance. A strategy with a low-dose step-up protocol and strict cancellation criteria is proposed. When multiple pregnancies are kept to a minimum, MOH/IUI is more cost-effective compared with in vitro fertilization and embryo transfer. Future research should focus on prediction models to predict the outcome of MOH/IUI treatment for individual couples before starting treatment.

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Risk factors for high-order multiple implantation after ovarian stimulation with gonadotrophins: evidence from a large series of 1878 consecutive pregnancies in a single centre

Abstract: This three-variable model can help to identify patients at high-risk for high-order multiple pregnancy in ovulation induction cycles.

Cited by 116 publications

References 37 publications

Babies born after ART treatment cost more than non-ART babies: a cost analysis of inpatient birth-admission costs of singleton and multiple gestation pregnancies

Babies born after ART treatment cost more than non-ART babies: a cost analysis of inpatient birth-admission costs of singleton and multiple gestation pregnancies

Relationship between inhibin A and B, estradiol and follicle growth dynamics during ovarian stimulation in normo-ovulatory women

Should We Continue Performing Intrauterine Inseminations in the Year 2004?

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