期刊
FERTILITY AND STERILITY
卷 97, 期 4, 页码 802-809出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.fertnstert.2012.02.031
关键词
Infertility; ovarian stimulation; intrauterine insemination; multiple births
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 Finally, we posit that OS/IUI is not likely to be superseded by IVF absent further commoditization and thus greater affordability. (Fertil Steril (R) 2012;97:802-9. (C)2012 by American Society for Reproductive Medicine.)
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