Strategies to reduce multiple pregnancies due to ovulation stimulation.
OBJECTIVE
To review factors associated with high-order multiple births (HOMB) due to ovulation induction (OI) and the efficacy of strategies to reduce their occurrence.


METHODS
Retrospective analysis of published studies of OI with intrauterine insemination (IUI) where patient and cycle characteristics were fully documented.


RESULTS
High-order multiple pregnancies (HOMP) were positively related to use of high doses of gonadotropin, number of 7-10 mm preovulatory follicles, and E(2), and inversely related to age and number of treatment cycles. Strategies successful in reducing HOMP include: use of clomiphene (CC) before gonadotropins, minimal gonadotropin doses, cancellation for more than three follicles >10-15 mm, and aspiration of excess follicles. Depending on the strategy used, 5%-20% of cycles may be canceled but HOMP rates can be less than 2% and pregnancy rates can average 10%-20% per cycle. Pregnancy rates per patient need not be reduced if low doses are continued for 4-6 cycles.


CONCLUSIONS
High-order multiple pregnancies due to OI can be reduced to 2% or less by less aggressive stimulation without reducing overall chances of pregnancy for most patients.
Dickey
Richard Palmer
RP
Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, The Fertility Institute of New Orleans, New Orleans, Louisiana, USA. rdickeyrei@fertilityinstitute.com
D002996:Clomiphene / Q000009:adverse effects*; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects*; D006801:Humans; D006080:Ovarian Follicle / Q000187:drug effects / Q000502:physiology; D010062:Ovulation Induction / Q000009:adverse effects*; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000502:physiology*; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects
D005300:Fertility Agents, Female; D002996:Clomiphene; D004958:Estradiol