title: Preventing high-order multiple pregnancies during controlled ovarian hyperstimulation and intrauterine insemination: 3 years' experience using low-dose recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists.
abstract: OBJECTIVE
  To employ protocols of mild ovarian stimulation to prevent an excessively elevated rate of high-order multiple pregnancies.
  
  
  METHODS
  Case series.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Six hundred and twenty one consecutive patients undergoing 1,259 controlled ovarian hyperstimulation and intrauterine insemination cycles.
  
  
  METHODS
  Patients received 50 IU per day of recombinant follicle-stimulating hormone (FSH) starting the third day of the cycle, then a gonadotropin-releasing hormone (GnRH) antagonist on the day in which a follicle > or =13 mm was visualized. Cycles were canceled if three or more follicles > or =16 mm and/or five or more follicles > or =11 mm were detected.
  
  
  METHODS
  Rate of high-order multiple pregnancies.
  
  
  RESULTS
  The clinical pregnancy rate per initiated cycle was 9.2% (95% confidence interval, 7.5-11.1%). The incidence of twins and high-order multiple pregnancies was 9.5% (95% CI, 5.3-16.2%) and 0 (0.0-3.2%), respectively.
  
  
  CONCLUSIONS
  In controlled ovarian hyperstimulation and intrauterine insemination cycles, a protocol of 50 IU of recombinant FSH daily combined with the use of GnRH antagonists and a policy of strict cancellation based on echographic criteria are associated with a satisfactory pregnancy rate per initiated cycle and a low risk of high-order multiple pregnancies.
authors.affiliation: Department of Obstetrics-Gynecology, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Ragni
authors.forename: Ilaria
authors.initials: I
authors.lastname: Caliari
authors.forename: Anna Elisa
authors.initials: AE
authors.lastname: Nicolosi
authors.forename: Mariangela
authors.initials: M
authors.lastname: Arnoldi
authors.forename: Edgardo
authors.initials: E
authors.lastname: Somigliana
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Crosignani
mesh_terms: D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage* / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006801:Humans; D007315:Insemination, Artificial; D006080:Ovarian Follicle / Q000000981:diagnostic imaging; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D011315:Preventive Medicine / Q000379:methods*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone