Conversion of high-response gonadotropin intrauterine insemination cycles to in vitro fertilization results in excellent ongoing pregnancy rates.
OBJECTIVE
To determine whether conversion of gonadotropin/IUI cycles at high risk of high-order multiple pregnancies to IVF yields a pregnancy rate high enough to warrant the added intervention.


METHODS
Case-control study.


METHODS
Brigham and Women's Hospital assisted reproductive technology program.


METHODS
Seventy-seven patients converted from gonadotropin/IUI to IVF, 77 consecutive age and attempt number-matched controls (sequential controls [SCs]), and 77 consecutive age-, attempt-, and E(2)-matched controls (E(2) controls [ECs]).


METHODS
Gonadotropin/IUI cycles with exuberant responses were converted to IVF (cases) to avoid cycle cancellation and high-order multiple pregnancies.


METHODS
Pregnancy rates, delivery rates, E(2) levels, follicle and oocyte number, and fertilization and implantation rates.


RESULTS
Compared with SCs and ECs, cases had more follicles (16.3 +/- 0.6 vs. 13.3 +/- 0.9 and 14.4 +/- 0.9) and higher E(2) at hCG administration (1,951 +/- 93 vs. 1,568 +/- 96 and 1,939 +/- 89 pg/mL). Delivery rates among the three groups (45.5% vs. 32.5% and 39.0%) did not differ significantly. Despite the transfer of fewer embryos in cases than in controls (2.5 +/- 0.1 vs. 3.1 +/- 0.1 and 2.9 +/- 0.1), three triplet pregnancies occurred in cases and three in controls.


CONCLUSIONS
Conversion of high responder gonadotropin/IUI patients to IVF is an effective alternative to cycle cancellation and offers a delivery rate as high or higher per cycle than that of planned IVF. Sample size limited the statistical power of the study.
Antman
Amy M
AM
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Politch
Joseph A
JA
Ginsburg
Elizabeth S
ES
D000328:Adult; D016022:Case-Control Studies; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D010064:Embryo Implantation; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage; D006062:Gonadotropins / Q000008:administration & dosage*; D006801:Humans; D007315:Insemination, Artificial; D016471:Ovarian Hyperstimulation Syndrome / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000453:epidemiology; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data
D006063:Chorionic Gonadotropin; D006062:Gonadotropins; D004958:Estradiol; D005640:Follicle Stimulating Hormone