Risk factors for high-order multiple pregnancy and multiple birth after controlled ovarian hyperstimulation: Results of 4,062 intrauterine insemination cycles

The Use of Gonadotropin Releasing Hormone Antagonist in Women Undergoing Intrauterine Insemination

“…It is acknowledged that the risk of multiple pregnancy as well as ovarian hyperstimulation syndrome is associated with the number of follicles as well as the age of the woman [21,22]. We found in this study that there were no significant differences about multiple pregnancies between the two groups, 84% of the pregnancies in the antagonist group were single and 16% were twins.…”

Factors Leading to Pregnancies in Stimulated Intrauterine Insemination Cycles and the Use of Consecutive Ejaculations Within a Small Clinic Environment

“…For women aged\32 years, HOMP (high-order multiple pregnancy) was 6 % for three to six follicles and 20 % for seven or more follicles. For ages 32-37 years, HOMP was 5 % for three to six follicles and 12 % for seven or more follicles [5]. However, careful monitoring of follicles has now reduced the absolute rate of multiple pregnancies is 0.3 % after monofollicular and 2.8 % after multifollicular growth [32].…”

“…A systematic review reported that further research through well designed studies was needed to unravel the determinants of success for IUI [4]. Despite several leads on the contributing factors for IUI such as woman's age, duration of infertility, follicle numbers, endometrial thickness, BMI, number of cycles of IUI and catheter types [5][6][7], ovulation induction, timing of insemination and total motile sperm numbers for IUI, none of the information has been presented in a way to serve as guidance on improving IUI pregnancy rates. Studies have shown that IUI is of little therapeutic benefit unless combined with ovulation induction [8,9] and IUI derives most of its therapeutic benefit from multifollicular development.…”

Clomiphene Citrate for Women with Unexplained Infertility

“…Serum estradiol levels on the day of hCG trigger 12) ** a Patients' age ≥ 43 and cycles with total initial motile sperm count < 5 million or motility < 30 % excluded b Patients with endometriosis, tubal impairment, and cycles with total initial motile sperm count < 5 million or motility < 30 % excluded c Patients' age ≥ 43, and patients with endometriosis and tubal factor excluded d Patients' age ≥ 43, patients with endometriosis and tubal factor, and cycles with total initial motile sperm count < 5 million or motility < 30 % excluded Dickey et al 2005 parallel the number of follicles ≥ 12 mm and reflect granulosa cell quantity and possibly quality [23]. The average estradiol level on the day of hCG trigger was 613 pg/ml in 524 CC-IUI cycles and 1194 pg/ml in 60 COH-IUI cycles performed for unexplained or male factor infertility, but the estradiol level per follicle ≥ 12 mm was similar, 254 pg/ml per follicle in patients using CC and 278 pg/ml per follicle in patients using gonadotropins [27].…”

“…In a prospective observational study of 4062 COH-IUI cycles, follicles as small as 10 mm on the day of spontaneous LH surge or hCG trigger contributed to triplet pregnancies [69]. It is necessary to count all follicles > 10 mm to assess the risk of triplet and higher order pregnancies (Table 25.5).…”