Prevention of multiple pregnancies after non-in vitro fertilization treatment

Intrauterine insemination: facts and fairy-tales

“…Although these trials were clinically heterogeneous, the probability of achieving a multiple pregnancy did seem to be related to the age of the woman, the total number of follicles and/or the number of follicles larger than 11 mm at hCG administration. The parameters found in these retrospective trials should be confirmed in large prospective trials using ROC curves to determine optimal cut-off values [6]. Several randomized trials on COH/IUI have been published using low-dose step-up protocols, with intensive monitoring and strict cancellation criteria.…”

“…On the other hand it significantly increases the risks of multiple pregnancies and/or ovarian hyperstimulation syndrome. It should therefore be applied only when proven effective, in experienced hands, with adequate monitoring, strict cancellation criteria and using low-dose step-up protocols [6].…”

Should We Continue Performing Intrauterine Inseminations in the Year 2004?

“…More randomized trials comparing different low-dose stimulation protocols for IUI (for instance 50 vs. 75 IU FSH/day) in a well-defi ned subfertile population using strict cancellation criteria should be conducted to defi ne the optimal stimulation protocol: acceptable pregnancy rates with only very few or even zero multiple pregnancies. Figure 2 shows a proposed strategy to prevent multiple pregnancies after MOH/IUI [12] . Other strategies to prevent high-order multiple pregnancies include aspiration of supernumerary follicles just before ovulation [29][30][31][32] and conversion to IVF [33,34] .…”

“…On the other hand, it signifi cantly increases the risks of multiple pregnancies and/or ovarian hyperstimulation syndrome. It should, therefore, be applied only when proven effective, in experienced hands, with adequate monitoring, strict cancellation criteria, and using low-dose step-up protocols [12] . In case of cervical hostility, the addition of MOH has never been proven effective in a large RCT.…”

“…The parameters found in these retrospective trials should be confi rmed in large prospective trials using receiver operating characteristic curves to determine optimal cutoff values. Finally, these parameters should be subject of internal and external validation before using them in daily practice [12] .…”