Ovarian stimulation and intrauterine insemination at the quarter centennial: implications for the multiple births epidemic

Capsule:
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.

Authors:
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 Finally, we posit that OS/IUI is not likely to be superseded by IVF absent further commoditization and thus greater affordability.

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