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Karnatak R, Agarwal A, Asnani M, Singh R. The Effect of Insulin Resistance on Ovulation Induction With Clomiphene Citrate in Non-polycystic Ovary Syndrome (PCOS) Women. Cureus 2022; 14:e27433. [PMID: 36051734 PMCID: PMC9420237 DOI: 10.7759/cureus.27433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To study the status of insulin resistance (IR) in non-polycystic ovary syndrome (PCOS) infertile women and to assess its effects on response to ovulation induction (OI) with clomiphene citrate (CC). Methods and materials A prospective cohort study was conducted at the Department of Obstetrics and Gynecology, King George Medical University, Lucknow, India, over a one-year period. One hundred two women who underwent treatment for infertility were enrolled and evaluated for insulin resistance. Insulin resistance was assessed using fasting serum insulin levels and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index. All participants were given ovulation induction with clomiphene citrate and were then followed up for the occurrence of ovulation and conception. Results Insulin resistance was found in 20.5% of infertile subjects and 95.4% of anovulatory subjects. Of the subjects with insulin resistance, 80.5% showed monofollicular development. The pregnancy rate was 5.8%, but there was no conception among subjects with insulin resistance. Conclusions Insulin resistance was found to be present in 20.5% of infertile women. Women with insulin resistance are more likely to have monofollicular development on ovulation induction and are less likely to conceive as compared with women without insulin resistance (OR = 0.2079).
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Hansen KR, Peck JD, Coward RM, Wild RA, Trussell JC, Krawetz SA, Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, Christman GM, Santoro N, Zhang H. Intrauterine insemination performance characteristics and post-processing total motile sperm count in relation to live birth for couples with unexplained infertility in a randomised, multicentre clinical trial. Hum Reprod 2021; 35:1296-1305. [PMID: 32432326 DOI: 10.1093/humrep/deaa027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/28/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Are intrauterine insemination (IUI) performance characteristics and post-processing total motile sperm count (TMC) related to live birth rate in couples with unexplained infertility? SUMMARY ANSWER Patient discomfort with IUI and lower inseminate TMC were associated with a reduced live birth rate, while time from hCG injection to IUI, sperm preparation method and ultrasound guidance for IUI were not associated with live birth success. WHAT IS ALREADY KNOWN We previously determined that some baseline characteristics of couples with unexplained infertility, including female age, duration of infertility, history of prior loss and income, were related to live birth rate across a course of ovarian stimulation and IUI treatment. However, the relationship between treatment outcomes and per-cycle characteristics, including ultrasound guidance for IUI, timing of IUI relative to hCG injection, difficult or painful IUI and inseminate TMC, are controversial, and most prior investigations have not evaluated live birth outcome. STUDY DESIGN, SIZE, DURATION This was a secondary analyses of 2462 cycles from the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial. This prospective, randomised, multicentre clinical trial determined live birth rates following IUI after ovarian stimulation with clomiphene citrate, letrozole or gonadotropins in 854 couples with unexplained infertility. It was conducted between 2011 and 2014, and couples could undergo up to four consecutive treatment cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS AMIGOS was an NIH-sponsored Reproductive Medicine Network trial conducted at 12 clinical sites. Participants were women with unexplained infertility who were between 18 and 40 years of age. Cluster-weighted generalised estimating equations (GEE), which account for informative clustering of multiple IUI treatment cycles within the same patient, were used to determine associations between IUI performance characteristics, including inseminate TMC, and live birth rate. Efficiency curves were also generated to examine the relationship between inseminate TMC and live birth rate. MAIN RESULTS AND THE ROLE OF CHANCE After adjustment for treatment group and baseline factors previously associated with live birth across a course of OS-IUI treatment, patient discomfort during the IUI procedure was associated with a reduction in live birth rate (aRR 0.40 (0.16-0.96)). Time from hCG trigger injection to IUI was not significantly associated with outcome. Higher TMC was associated with greater live birth rate (TMC 15.1-20.0 million (14.8%) compared to ≤5 million (5.5%)) (aRR 2.09 (1.31-3.33)). However, live births did occur with TMC ≤ 1 million (5.1%). LIMITATIONS, REASONS FOR CAUTION This investigation is a secondary analysis, and AMIGOS was not designed to address the present question. Since timed intercourse was allowed as part of the AMIGOS trial, we cannot rule out the possibility that any given pregnancy resulted from intercourse rather than IUI. WIDER IMPLICATIONS OF THE FINDINGS Most factors associated with the performance of IUI were not significantly related to obtaining live birth. Our findings suggest that higher TMC inseminated leads to an increase in live birth rate up to TMC ~20 million. However, there may be no reasonable threshold below which live birth is not possible with IUI. STUDY FUNDING/COMPETING INTEREST(S) Funding was received through grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): U10 HD077680, U10 HD39005, U10 HD38992, U10 HD27049, U10 HD38998, U10 HD055942, HD055944, U10 HD055936 and U10 HD055925. This research was made possible by funding by the American Recovery and Reinvestment Act. Dr Hansen reports grants from NIH/NICHD and Yale University during the conduct of the study, grants from Roche Diagnostics and grants from Ferring International Pharmascience Center US outside the submitted work. Dr Peck reports support from Ferring Pharmaceuticals outside the submitted work. Dr Coward has nothing to disclose. Dr Wild reports grants from NICHD during the conduct of the study. Dr Trussell has nothing to disclose. Dr Krawetz reports grants from NICHD during the conduct of the study, grants from Merck and support from Taylor and Frances and from Springer, outside the submitted work. Dr Diamond reports grants from NIH/NICHD, Yale University, during the conduct of the study and support from Advanced Reproductive Care AbbVie, Bayer and ObsEva, outside the submitted work. Dr Legro reports support from Bayer, Kindex, Odega, Millendo and AbbVie and grants and support from Ferring, outside the submitted work. Dr Coutifaris reports grants from NICHD/NIH and personal fees from American Society for Reproductive Medicine, outside the submitted work. Dr Alvero has nothing to disclose. Dr Robinson reports grants from NIH during the conduct of the study. Dr Casson has nothing to disclose. Dr Christman reports grants from NICHD during the conduct of the study. Dr Santoro reports grants from NIH during the conduct of the study. Dr Zhang reports grants from NIH during the conduct of the study and support from Shangdong University outside the submitted work. TRIAL REGISTRATION NUMBER n/a.
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Affiliation(s)
- Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA
| | - Jennifer D Peck
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA.,Department of Biostatistics and Epidemiology, University of Oklahoma College of Public Health, Oklahoma City, OK 73104, USA
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, 2113 Physicians Office Building CB#7235, Chapel Hill, NC 27599-7235, USA.,UNC Fertility, 7920 ACC Blvd #300, Raleigh, NC 27617, USA
| | - Robert A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA.,Department of Biostatistics and Epidemiology, University of Oklahoma College of Public Health, Oklahoma City, OK 73104, USA
| | - J C Trussell
- Department of Urology, Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology and Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA.,Department of Obstetrics and Gynecology, Augusta University, Augusta, GA 30912, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, PA 17033, USA
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, USA.,Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, CA 94087, USA
| | - Randal D Robinson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, TX 78229, USA
| | - Peter Casson
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, VT 05446, USA.,Northeastern Reproductive Medicine, 105 W View Rd, #302, Colchester, VT 05446, USA
| | - Gregory M Christman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Obstetrics and Gynecology, University of Florida College of Medicine, PO Box 100294, Gainesville, FL 32610, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, USA
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT 06520, USA
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Mollaahmadi L, Keramat A, Ghiasi A, Hashemzadeh M. The relationship between semen parameters in processed and unprocessed semen with intrauterine insemination success rates. J Turk Ger Gynecol Assoc 2018; 20:1-7. [PMID: 30222125 PMCID: PMC6501869 DOI: 10.4274/jtgga.galenos.2018.2018.0089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate the relationship between semen parameters and intrauterine insemination (IUI) success rates. Material and Methods: This retrospective study was conducted during a 4-year period (2011-2015) on the medical records of 350 couples admitted to the infertility center of Beast Hospital in Tehran. The participants’ data such as age, duration of infertility, semen parameters [including volume, concentration, motility, normal morphology and total motile sperm count (TMSC)] before and after sperm processing, as well as the IUI results were extracted from the patients’ records. Only the first IUI cycle of the couples was considered. The main outcome criterion for the IUI success was serum positive beta human chorionic gonadtotropin 14 days after IUI. The collected data were analyzed using the Mann-Whitney U test, chi-square, and Fisher’s exact tests. Results: The overall pregnancy rate for each couple was reported as 23.42% (82/350). There was no significant difference in the mean age of the couple and infertility duration between the groups who achieved pregnancy and those who failed. The two groups showed no significant differences in pre and post processing of semen parameters (including volume, concentration and TMSC). Sperm motility and normal sperm morphology before and after sperm processing were significantly different between the two groups, respectively (p=0.023 before sperm processing and p=0.032 after) (p=0.032 before sperm processing and p=0.007 after). Conclusion: Sperm motility and normal sperm morphology have an effect in IUI success.
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Affiliation(s)
- Leila Mollaahmadi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ashraf Ghiasi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mozhgan Hashemzadeh
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Hansen KR, Eisenberg E, Baker V, Hill MJ, Chen S, Talken S, Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, Christman GM, Santoro N, Zhang H, Wild RA. Midluteal Progesterone: A Marker of Treatment Outcomes in Couples With Unexplained Infertility. J Clin Endocrinol Metab 2018; 103:2743-2751. [PMID: 29767754 PMCID: PMC6276712 DOI: 10.1210/jc.2018-00642] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Adequate luteal phase progesterone exposure is necessary to induce endometrial changes required for a successful pregnancy outcome. The relationship between low midluteal progesterone concentration and the outcome of live birth in ovarian stimulation with intrauterine insemination (OS-IUI) treatments is not defined. OBJECTIVE To determine the level of midluteal progesterone portending a low chance of live birth after OS-IUI in couples with unexplained infertility. DESIGN AND SETTING Secondary analyses of data from a prospective, randomized, multicenter clinical trial that determined pregnancy outcomes following OS-IUI with clomiphene citrate, letrozole, or gonadotropins for couples with unexplained infertility. PARTICIPANTS Couples (n = 900) underwent 2376 OS-IUI cycles during the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation clinical trial. MAIN OUTCOME MEASURES Live birth as it relates to midluteal progesterone level and thresholds below which no live births occur by treatment group. RESULTS Thresholds for non-live birth cycles were similar for clomiphene (14.4 ng/mL) and letrozole (13.1 ng/mL) yet were lower for gonadotropin (4.3 ng/mL) treatments. A midluteal progesterone level >10th percentile specific for each treatment group independently was associated with greater odds for a live birth in all OS-IUI cycles (adjusted OR: 2.17; 95% CI: 1.05, 4.48). CONCLUSIONS During OS-IUI, a low midluteal progesterone level was associated with a low probability of live birth. Thresholds differed by medication, with the lowest threshold for gonadotropin. Several pathophysiologic mechanisms may account for low progesterone levels. Refinement of the predictive range associated with particular ovarian stimulation medications during treatment of unexplained infertility may improve accuracy.
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Affiliation(s)
- Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Correspondence and Reprint Requests: Karl R. Hansen, MD, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Boulevard, AAT 2444, Oklahoma City, Oklahoma 73104. E-mail:
| | - Esther Eisenberg
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Valerie Baker
- Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California
| | - Micah J Hill
- Reproductive Endocrinology and Infertility Fellowship, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sara Talken
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, Pennsylvania
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado
| | - Randal D Robinson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Peter Casson
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont
| | - Gregory M Christman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Robert A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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The role of steroid hormone supplementation in non–assisted reproductive technology treatments for unexplained infertility. Fertil Steril 2016; 106:1600-1607. [DOI: 10.1016/j.fertnstert.2016.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 08/18/2016] [Accepted: 09/07/2016] [Indexed: 11/23/2022]
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Success in pregnancy through intrauterine insemination at first cycle in 300 infertile couples: an analysis. J Obstet Gynaecol India 2014; 64:134-42. [PMID: 24757343 DOI: 10.1007/s13224-013-0484-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The aim of this article was to determine digital levels of the association of factors of pregnancy success after the first cycle of intrauterine insemination (IUI) with 300 infertile couples. METHODS The IUI procedure was followed at 36 h after triggering the ovulation, if at least one follicle measured >15 mm. Endometrium thickness (ET) and serum luteinizing hormone (LH) levels were measured at day 10 for each patient. The post-wash total motile fraction (TMF) of semen of the partner of each patient was also evaluated. The principal component analysis (PCA) was done with the data to quantify the associations of related factors. RESULTS The clinical pregnancy rate of first cycle IUI attempts was 17.3 %, observed in females, aged 20-39 years and men with TMF >5 million spermatozoa. The ovarian stimulation enabled the development of follicles measuring >16 mm, with LH levels <10 mIU/L and ET >5 mm for success. The PCA revealed that with the female-age parameter, three factors, NF, ET, and LH were related in the component 1; similarly, NF, LH, and RFS were related in component 2; age, NF, ET, LH, LFS, and TMF were related in component 3; and NF, ET, LH, RFS, and LFS in component 4 were related, i.e., the best correlation. CONCLUSIONS Associated principal determinative factors, LH, female-age, NF and LFS values were highly significant, but the factors, ET, RFS and TMF were statistically insignificant for success through IUI in pregnancy.
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Hullender Rubin L, Marx BL. Diminished Ovarian Reserve, Clomid, and Traditional Chinese Medicine: A Case Study. Med Acupunct 2012; 24:273-280. [PMID: 24761166 DOI: 10.1089/acu.2012.0912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Infertility caused by diminished ovarian reserve (DOR) can result from an endocrinological imbalance. A rise in follicle stimulating hormone (FSH) and decrease in antral follicle count (AFC) for women age ≤35 can lower pregnancy rates to <5%, and increase miscarriage rates to >75%. Chinese medicine may improve FSH and AFC levels in patients with DOR. It is common for women to seek adjunctive Traditional Chinese Medicine (TCM) treatment with biomedical clomid treatment. OBJECTIVE This article reports the case of a female with DOR who had completed three multiple, serial clomid cycles from September to December 2005, and for whom clomid failed. DESIGN SETTING AND PATIENT This is a case study of a 34-year-old patient with a 5-year history of infertility caused by DOR. She was treated in a private practice in Bellevue, WA. INTERVENTION TCM treatment-including acupuncture and herbal therapy-lasted from from January 2007 to April 2007. MAIN OUTCOME MEASURES The main outcomes sought were improvements in this patient's reproductive hormone panel, including tests for FSH, estradiol, and AFC levels; in addition a pregnancy outcome was desired. RESULTS After 4 months of TCM treatment, the patient returned to biomedical care. Pregnancy was not achieved during three more clomid cycles, although she had improvements her levels of FSH (from 14.5 mIU/mL to 8.7 mIU/mL) and AFC (from 10-12 to 16-18 total). After 3 more cycles with clomid, her FSH level increased to 16.8 mIU/mL and her AFC level was <10. CONCLUSIONS After three failed clomid cycles, a patient with DOR had improved FSH and AFC levels when she received TCM treatment. However, this patient was still unable to conceive although three more clomid cycles were attempted. More research is needed to discern demographically which patients benefit best from multiple, serial clomid interventions. In addition, it is important to investigate more-integrative treatments for patients with DOR, including assisted reproductive techniques, acupuncture, and Chinese herbs.
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Affiliation(s)
| | - Benjamin L Marx
- Research Department, Oregon College of Oriental Medicine , Portland, OR
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Schieve LA, Devine O, Boyle CA, Petrini JR, Warner L. Estimation of the contribution of non-assisted reproductive technology ovulation stimulation fertility treatments to US singleton and multiple births. Am J Epidemiol 2009; 170:1396-407. [PMID: 19854803 DOI: 10.1093/aje/kwp281] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Infertility treatments that include ovulation stimulation, both assisted reproductive technologies (ARTs) and non-ART ovulation stimulation, are associated with increased risks of multiple birth and concomitant sequelae and adverse outcomes, even among singletons. While a US surveillance system for ART-induced births is ongoing, no population-based tracking system exists for births resulting from non-ART treatments. The authors developed a multistage model to estimate the uncertain proportion of US infants born in 2005 who were conceived by using non-ART ovulation treatments. Using published surveillance data, they estimated proportions of US multiple births conceived naturally and by ART and assumed that the remainder were conceived with non-ART treatments. They used Bayesian meta-analyses to summarize published clinical studies on the multiple-gestation risk associated with non-ART ovulation treatments, applied a fetal survival factor, and used this multiple-birth risk estimate and their own estimate of the proportion of US multiple births attributable to non-ART ovulation stimulation to estimate the total (and, through subtraction, singleton) proportion of infants conceived with such treatments. On the basis of the model, the authors estimate that 4.6% of US infants born in 2005 (95% uncertainty range: 2.8%-7.1%) resulted from non-ART ovulation treatments. Notably, this figure is 4 times greater than the ART contribution.
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Affiliation(s)
- Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS E-86, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Freiesleben NLC, Lossl K, Bogstad J, Bredkjaer HE, Toft B, Loft A, Bangsboll S, Pinborg A, Budtz-Jørgensen E, Andersen AN. Predictors of ovarian response in intrauterine insemination patients and development of a dosage nomogram. Reprod Biomed Online 2009; 17:632-41. [PMID: 18983747 DOI: 10.1016/s1472-6483(10)60310-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this prospective study was to identify predictors of ovarian response in ovulatory patients treated with low-dose recombinant FSH (rFSH), gonadotrophin-releasing hormone antagonist and intrauterine insemination (IUI), and to develop an rFSH dosage nomogram based on the findings. Patients (n = 159) were stimulated with a starting dose of 75 IU rFSH/day. Ten parameters were investigated as possible predictors of the number of mature follicles >or=15 mm: age, spontaneous cycle length, body weight, body mass index, smoking status, total ovarian volume, total number of antral follicles, total Doppler score of the ovarian stromal blood flow, baseline FSH and oestradiol. Simple and multiple linear regressions were used for the statistical analysis. Appropriate ovarian response was defined as two to three mature follicles. Body weight (P = 0.001) and the number of antral follicles (P = 0.004) were the strongest independent predictive factors of the number of mature follicles. In conclusion, body weight and antral follicle count may be used to achieve appropriate ovarian response for IUI in ovulatory patients. Based on this, a simple rFSH dosage nomogram was developed for individual ovarian stimulation prior to IUI.
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Affiliation(s)
- N L C Freiesleben
- The Fertility Clinic, Department 4071, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
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Dickey RP. Strategies to reduce multiple pregnancies due to ovulation stimulation. Fertil Steril 2008; 91:1-17. [PMID: 18973894 DOI: 10.1016/j.fertnstert.2008.08.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 08/05/2008] [Indexed: 11/17/2022]
Abstract
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. DESIGN Retrospective analysis of published studies of OI with intrauterine insemination (IUI) where patient and cycle characteristics were fully documented. RESULT(S) 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. CONCLUSION(S) 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.
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Affiliation(s)
- Richard Palmer Dickey
- Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, The Fertility Institute of New Orleans, New Orleans, Louisiana, USA.
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11
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van Rumste M, Custers I, van der Veen F, van Wely M, Evers J, Mol B. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a meta-analysis. Hum Reprod Update 2008; 14:563-70. [DOI: 10.1093/humupd/dmn034] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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