title: A conservative treatment protocol with human menopausal gonadotropins aimed at reducing multiple births.
abstract: In multicenter studies involving 3002 courses of human menopausal gonadotropins (hMG) therapy in 1286 patients, 20% of the patients who delivered had multiple gestations; 75% of these were twins and 25% were triplets or higher parity. Our stimulation regimen is very conservative in that we 1) try to allow a female with LPD and regular cycles but not reaching a mature follicle to first select her dominant follicle and wait until the serum E2 reaches approximately 100 pg/mL then add the hMG. With anovulatory women we frequently begin with only 75 IU hMG and gradually increase the hMG dosage. Using this approach we have usually attained at least a 70% pregnancy rate in six months. A study was performed to see if this conservative approach resulted in a decreased multiple birth rate percentage especially with triplets or more. The study was to evaluate the outcome of 241 consecutive pregnancies in which hMG was the sole therapy. There were 203 with one gestation and 38 with multiples. Twins--32; triplets--6. Thus 15% (38/241) had multiple births; six of 38 (15%) of the multiples had triplets or more. Though our multiple birth rate and especially higher parity rate appears to be lower than average no statistical difference was found. Thus even with conservative use of hMG multiple births cannot be easily avoided.
authors.affiliation: University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, New Jersey.
authors.forename: J H
authors.initials: JH
authors.lastname: Check
authors.forename: J S
authors.initials: JS
authors.lastname: Chase
authors.forename: H G
authors.initials: HG
authors.lastname: Adelson
authors.forename: C
authors.initials: C
authors.lastname: Lauer
authors.forename: B
authors.initials: B
authors.lastname: Schubert
mesh_terms: D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008596:Menotropins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology / Q000517:prevention & control; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal
chemical_list: D011374:Progesterone; D004958:Estradiol; D008596:Menotropins; D007986:Luteinizing Hormone