Strategies to reduce multiple pregnancies due to ovulation stimulation

Dickey, Richard P.

doi:10.1016/j.fertnstert.2008.08.008

Cited by 60 publications

(47 citation statements)

References 111 publications

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“…During the 1980s the traditional protocol was modified to include IVF after three unsuccessful cycles of COH-IUI. An important reason for use of CC or CC-IUI before COH is that it reduces the risk of twins and triplets and higher order multiple pregnancy (HOMP) [32,33]. A recent alternative to the traditional protocol is to eliminate COH-IUI and proceed directly to IVF when pregnancy does not occur after three cycles of CC-IUI [34].…”

Section: Cervical Mucusmentioning

confidence: 99%

Evaluation of Women with Unexplained Infertility

Dickey

2015

Unexplained Infertility

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Section: Cervical Mucusmentioning

confidence: 99%

Evaluation of Women with Unexplained Infertility

Dickey

2015

Unexplained Infertility

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“…Indeed, the goal of fertility treatment with ovulation induction or stimulation should always be the same: the birth of one, or at most two, babies [14,15].…”

Section: Discussionmentioning

confidence: 99%

Rescue in vitro fertilization using a GnRH antagonist in hyper-responders from gonadotropin intrauterine insemination (IUI) cycles

Balayla

Granger

St-Michel³

et al. 2013

J Assist Reprod Genet

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Objective To evaluate the outcomes in the conversion of high-response gonadotropin intrauterine insemination (IUI) cycles to "rescue" in vitro fertilization (IVF) using a Gonadotropin-Releasing Hormone (GnRH) antagonist, with regards to implantation rates, pregnancy rates, cost, and ovarian hyperstimulation syndrome (OHSS) as compared to matched, hyper-responder, IVF controls. Methods This prospective cohort study was conducted between January 2007 and December 2009 at our institution. In order to decrease high-order multiple pregnancy, minimize the incidence of OHSS, and avoid cycle cancellation, highresponse stimulated-IUI patients opted to convert to "rescue" IVF using the GnRH antagonist cetrorelix acetate. We then compared their clinical outcomes with matched patients from high-response IVF cycles of the standard long mid-luteal GnRH agonist protocol (14 or more collected oocytes). Only cases of conventional IVF without intra-cytoplasmic sperm injection (ICSI) were included in the control group.Results Out of 184 patients undergoing stimulated-IUI cycles with gonadotropins, 87 patients developed a hyperresponse, and 20 opted to convert to "rescue" IVF. These patients were compared with 157 matched, hyper responder IVF controls from our registry. The implantation rate was 25.6 % in the "rescue" IVF group and 20.7 % in the control IVF group (p<0.0047). The ongoing clinical pregnancy rate per embryo transfer was 45.0 % and 33.6 % in the "rescue" IVF and the control IVF groups, respectively (p<0.0001). The mean duration of stimulation was comparable between cohorts (10.0 vs.10.4 days, p=0.6324). The mean dose of gonadotropin used per cycle was higher in the control group, 2664 international units (IU) of follicle stimulation hormone (FSH) compared to 1450 IU of FSH in the "rescue" IVF group (p<0.0001). The incidence of severe OHSS is also higher in the control group, 5.1 % versus no cases in the "rescue" IVF group (p<0.0001). Conclusion Our study demonstrates that conversion of high-response gonadotropin-IUI cycles to "rescue" IVF using a GnRH antagonist is a cost-effective strategy that produces better results than regular IVF with relatively minimal morbidity, and shorter duration to achieve pregnancy. Implantation and ongoing clinical pregnancy rates tend to be higher than those from hyper-responder regular IVF patients. Capsule Conversion of high-response gonadotropin-IUI cycles to "rescue" IVF using a GnRH antagonist is a cost-effective strategy that produces better results than regular IVF.

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“…Cancelling cycles when response is excessive is imperative to keeping multiple pregnancy rates down. Having a 5-20% cancellation rate has been shown to be associated with a less than 2% higher order multiple pregnancy rate and no difference in pregnancy rates over 4 cycles, and patients should be thoroughly counselled about this [41].…”

Section: Gonadotrophinsmentioning

confidence: 99%

Fertility Treatment for Women with PCOS

Langdon¹,

Pontré²,

Hart³

2017

Testes and Ovaries - Functional and Clinical Differences and Similarities

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Polycystic ovarian syndrome is the commonest cause of anovulatory infertility. This chapter will explore fertility treatment options for this condition including the risks, benefits and success rates for different treatment methods. The importance of close patient monitoring with hormone levels and pelvic ultrasounds to ensure mono-ovulation and to avoid ovarian hyperstimulation syndrome will be highlighted.

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Strategies to reduce multiple pregnancies due to ovulation stimulation

Cited by 60 publications

References 111 publications

Evaluation of Women with Unexplained Infertility

Evaluation of Women with Unexplained Infertility

Rescue in vitro fertilization using a GnRH antagonist in hyper-responders from gonadotropin intrauterine insemination (IUI) cycles

Fertility Treatment for Women with PCOS

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