Does empiric superovulation improve fecundity in healthy women undergoing therapeutic donor insemination without a male partner?

Abstract

Objective: To evaluate whether superovulation improves fecundity in women undergoing therapeutic donor insemination (TDI). Design: Retrospective cohort study. Setting: University-affiliated fertility clinic. Patient(s): Healthy women aged 23-45 years with no history of or risk factors for infertility who underwent 152 medicated and 104 unmedicated TDI cycles from 2013 to 2018. Intervention: Unmedicated TDI versus use of medication in a TDI cycle (clomiphene citrate or letrozole). Main Outcome Measure(s): Cumulative probability of pregnancy in six TDI cycles. Result(s):In adjusted all-cycle analysis, medicated TDI cycles were less likely to result in pregnancy compared with unmedicated cycles. The incidence of twins was 23% in the medicated group and 0% in the unmedicated group. Medicated cycles were less likely to result in pregnancy in women younger than 40 years or with an antim€ ullerian hormone (AMH) level >1.2. After three cycles not resulting in pregnancy, the only women who conceived were those who crossed over from an unmedicated to a medicated cycle (12% vs. 0%). Conclusion(s):Patients undergoing unmedicated TDI cycles had higher fecundity and no incidence of twin gestations. Older women, those with low AMH, and those who fail to conceive after three unmedicated cycles may benefit from medication. (Fertil Steril Ò 2020;113:114-20. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Does ovarian stimulation benefit ovulatory women undergoing therapeutic donor insemination?

“…Our findings are different from the study by Hawkins Bressler et al (9) that showed decreased fecundity with the use of OS. When comparing the two studies, those investigators used a combination of CC and letrozole, yet they only found reduced fecundity with the use of letrozole.…”

“…A recent study by Hawkins Bressler et al (9) sought to examine the difference in fecundity between NC IUI versus superovulation IUI with either CC or letrozole in women undergoing donor insemination without a male partner. Only women without a diagnosis of infertility were included.…”

“…When a subgroup analysis was performed, they found no difference in fecundity between unmedicated and CC cycles, yet found significantly lower fecundity with use of letrozole. It is important to note that the sample size of this study (9) was small and included only 101 women with a total of 256 cycles eligible for analysis.…”

Ovulation induction with therapeutic donor sperm insemination in fertile patients: perhaps less is more

“…In heterosexual couples with unexplained subfertility, ovulation induction with intrauterine insemination (IUI) is thought to improve chances of pregnancy over a natural cycle with IUI (3). In contrast, prior retrospective data suggest there is no benefit to superovulation with clomiphene citrate or letrozole for women undergoing therapeutic donor insemination (4).…”