Relationship of follicle numbers and estradiol levels to multiple implantation in 3,608 intrauterine insemination cycles.
OBJECTIVE
To determine the relationship of follicle numbers and estradiol (E(2)) levels to multiple implantations in human menopausal gonadotropin (hMG) and clomiphene citrate (CC) cycles.


METHODS
Fifteen-year prospective study.


METHODS
Private infertility clinic.


METHODS
Women who underwent 3608 cycles of husband or donor intrauterine insemination (IUI).


METHODS
Ovulation induction (OI) with CC, hMG, or CC+hMG.


METHODS
Pregnancy and multiple implantations.


RESULTS
Triplet and higher-order implantations-but not twin implantations-were related to age, E(2) levels, and number of follicles > or = 12 mm and > or = 15 mm, but not number of follicles > or = 18 mm, in hMG and CC+hMG cycles. For patients less than 35 years old, three or more implantations tripled when six or more follicles were > or = 12 mm, in CC, hMG, and CC+hMG cycles, and when E(2) was > or = 1000 pg mL in hMG and CC+hMG cycles. For patients 35 or older, pregnancy rates in hMG and CC+hMG cycles doubled when six or more follicles were > or = 12 mm, or E(2) levels were >1000 pg mL, whereas 3 or more implantations were not significantly increased.


CONCLUSIONS
Withholding hCG or IUI in CC, hMG, and CC+hMG cycles when six or more follicles are > or = 12 mm may reduce triplet and higher-order implantations by 67% without significantly reducing pregnancy rates for patients under 35 years of age.
Dickey
R P
RP
The Fertility Institute of New Orleans, New Orleans, Louisiana 70128, USA.
Taylor
S N
SN
Lu
P Y
PY
Sartor
B M
BM
Rye
P H
PH
Pyrzak
R
R
D000328:Adult; D000367:Age Factors; D002996:Clomiphene / Q000008:administration & dosage / Q000627:therapeutic use; D004343:Drug Implants; D004958:Estradiol / Q000097:blood*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D007315:Insemination, Artificial / Q000502:physiology*; D008596:Menotropins / Q000008:administration & dosage / Q000627:therapeutic use*; D009099:Multiple Birth Offspring; D006080:Ovarian Follicle / Q000166:cytology*; D010060:Ovulation / Q000187:drug effects; D011247:Pregnancy; D011446:Prospective Studies; D014310:Triplets; D014427:Twins
D004343:Drug Implants; D005300:Fertility Agents, Female; D002996:Clomiphene; D004958:Estradiol; D008596:Menotropins