Objective: To employ protocols of mild ovarian stimulation to prevent an excessively elevated rate of high- order multiple pregnancies. Design: Case series. Setting: University hospital. Patient(s): Six hundred and tw...Objective: To employ protocols of mild ovarian stimulation to prevent an excessively elevated rate of high- order multiple pregnancies. Design: Case series. Setting: University hospital. Patient(s): Six hundred and twenty one consecutive patients undergoing 1,259 controlled ovarian hyperstimulation and intrauterine insemination cycles. Intervention(s): Patients received 50 IU per day of recombinant follicle- stimulating hormone (FSH) starting the third day of the cycle, then a gonadotropin- releasing hormone (GnRH) antagonist on the day in which a follicle<13 mm was visualized. Cycles were canceled if three or more follicles < 16 mm and/or five or more follicles < 11 mm were detected. Main Outcome Measure(s): Rate of high- order multiple pregnancies. Result(s): The clinical pregnancy rate per initiated cycle was 9.2% (95% confidence interval, 7.5- 11.1% ). The incidence of twins and high- order multiple pregnancies was 9.5% (95% CI, 5.3- 16.2% ) and 0 (0.0- 3.2% ), respectively. Conclusion(s): In controlled ovarian hyperstimulation and intrauterine insemination cycles, a protocol of 50 IU of recombinant FSH daily combined with the use of GnRH antagonists and a policy of strict cancellation based on echographic criteria are associated with a satisfactory pregnancy rate per initiated cycle and a low risk of high- order multiple pregnancies.展开更多
文摘Objective: To employ protocols of mild ovarian stimulation to prevent an excessively elevated rate of high- order multiple pregnancies. Design: Case series. Setting: University hospital. Patient(s): Six hundred and twenty one consecutive patients undergoing 1,259 controlled ovarian hyperstimulation and intrauterine insemination cycles. Intervention(s): Patients received 50 IU per day of recombinant follicle- stimulating hormone (FSH) starting the third day of the cycle, then a gonadotropin- releasing hormone (GnRH) antagonist on the day in which a follicle<13 mm was visualized. Cycles were canceled if three or more follicles < 16 mm and/or five or more follicles < 11 mm were detected. Main Outcome Measure(s): Rate of high- order multiple pregnancies. Result(s): The clinical pregnancy rate per initiated cycle was 9.2% (95% confidence interval, 7.5- 11.1% ). The incidence of twins and high- order multiple pregnancies was 9.5% (95% CI, 5.3- 16.2% ) and 0 (0.0- 3.2% ), respectively. Conclusion(s): In controlled ovarian hyperstimulation and intrauterine insemination cycles, a protocol of 50 IU of recombinant FSH daily combined with the use of GnRH antagonists and a policy of strict cancellation based on echographic criteria are associated with a satisfactory pregnancy rate per initiated cycle and a low risk of high- order multiple pregnancies.
