Ovarian stimulation and intrauterine insemination at the quarter centennial: implications for the multiple births epidemic
Ovarian stimulation/intrauterine insemination is a significant determinant of the multiple birth epidemic. Redress will require a rethinking of practice patterns. Herein we explore the prospects of prevention, mitigation, and eventual resolution.
Howard D. McClamrock, M.D., Howard W. Jones Jr., M.D., Eli Y. Adashi, M.D., M.S.
Volume 97, Issue 4 , Pages 802-809, April 2012
Ovarian stimulation and intrauterine insemination (OS/IUI), a mainstay of current infertility therapy and a common antecedent to IVF, is a significant driver of the multiple births epidemic. Redress of this challenge, now marking its quarter centennial, will require a rethinking of current practice patterns. Herein we explore prospects for prevention, mitigation, and eventual resolution. We conclude that the multiple births attributable to OS/IUI may not be entirely preventable but that the outlook for their mitigation is promising, if in need of solidification. Specifically, we observe that low-dose (≤75 IU) gondotropin, clomiphene, and especially off-label letrozole regimens outperform high-dose (≥150 IU) gonadotropin counterparts in the gestational plurality category while maintaining comparable per-cycle pregnancy rates. Accordingly we recommend that, subject to appropriate exceptions, high-dose gonadotropin regimens be used sparingly and that whenever possible they be replaced with emerging alternatives. Finally, we posit that OS/IUI is not likely to be superseded by IVF absent further commoditization and thus greater affordability.