title: Relationship of follicle numbers and estradiol levels to multiple implantation in 3,608 intrauterine insemination cycles.
abstract: 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.
authors.affiliation: The Fertility Institute of New Orleans, New Orleans, Louisiana 70128, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Dickey
authors.forename: S N
authors.initials: SN
authors.lastname: Taylor
authors.forename: P Y
authors.initials: PY
authors.lastname: Lu
authors.forename: B M
authors.initials: BM
authors.lastname: Sartor
authors.forename: P H
authors.initials: PH
authors.lastname: Rye
authors.forename: R
authors.initials: R
authors.lastname: Pyrzak
mesh_terms: 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
chemical_list: D004343:Drug Implants; D005300:Fertility Agents, Female; D002996:Clomiphene; D004958:Estradiol; D008596:Menotropins