| Ovarian stimulation and intrauterine insemination at the quarter centennial: implications for the multiple births epidemic. | |
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MedLine Citation:
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PMID: 22463774 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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 Finally, we posit that OS/IUI is not likely to be superseded by IVF absent further commoditization and thus greater affordability.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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Authors:
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Howard D McClamrock; Howard W Jones; Eli Y Adashi |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Fertility and sterility Volume: 97 ISSN: 1556-5653 ISO Abbreviation: Fertil. Steril. Publication Date: 2012 Apr |
Date Detail:
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Created Date: 2012-04-02 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372772 Medline TA: Fertil Steril Country: United States |
Other Details:
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Languages: eng Pagination: 802-9 Citation Subset: IM |
Copyright Information:
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Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Shady Grove Fertility, Baltimore, Maryland; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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