Analysis was limited to cycles in which women conceived. Gonadotrophin-releasing hormone antagonists for assisted conception. Cochrane Database. The inability of preovulatory ovarian scans to predict multifetal pregnancy occurrence in a follow-up of induction of ovulation with menotropins. Google Scholar Crossref. Search ADS. Intrauterine insemination versus fallopian tube sperm perfusion for non tubal infertility.
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Controlled ovarian hyperstimulation and intrauterine insemination for treatment of infertility. Comparison of controlled ovarian stimulation with human menopausal gonadotropin or recombinant follicle-stimulating hormone. Efficacy of low-dose human chorionic gonadotropin alone to complete controlled ovarian stimulation. Reducing the risk of high-order multiple pregnancy after ovarian stimulation with gonadotropins. Controlled ovarian hyperstimulation and intrauterine insemination for infertility associated with endometriosis: a retrospective analysis.
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Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. Assessing the risk of multiple gestation in gonadotropin intrauterine insemination cycles. Cycle fecundity in controlled ovarian hyperstimulation and intrauterine insemination. Influence of the number of mature follicles at hCG administration. Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of cycles.
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Investigation of correlative factors affecting successful intrauterine insemination. Is twin pregnancy necessarily an adverse outcome of assisted reproductive technologies? All rights reserved. For Permissions, please email: journals. Issue Section:. Download all slides. View Metrics. Email alerts Article activity alert. Advance article alerts. New issue alert. Receive exclusive offers and updates from Oxford Academic.
More on this topic Intrauterine insemination. The impact of intentional endometrial injury on reproductive outcomes: a systematic review and meta-analysis. IUI for unexplained infertility—a network meta-analysis. Intrauterine insemination: a systematic review on determinants of success. Related articles in Web of Science Google Scholar. Here, the goal of IUI is simply to get sperm to the right place at the right time.
This ultrasound sets the schedule for the cycle. This medication is an injection with a small needle in the abdomen. The IUI is scheduled 36 hours after the trigger medication is injected.
Awaiting Natural Ovulation: Blood work or urine-based ovulation predictor kits OPKs can predict when a woman will naturally ovulate. In this case, the IUI occurs either later that day or the next morning. Anovulatory Patients: Can start medication at any time. In this case, a 7 to 10 day course of progesterone like provera or aygestin can be given to cause the onset of a period and clomid or letrozole would be started thereafter. Unexplained Patients: Can start medication on day 3 or 5 of the cycle.
If the patient is having her treatment cycle monitored, she will come in on day 3 for bloodwork and an ultrasound.
On ultrasound, the doctor will be checking to make sure that no follicles have already started the process of growing because once one follicle is already growing, it is unlikely that others will also start growing in response to clomid or letrozole. The doctor will also look at estrogen levels through blood work to confirm this.
Once the patient has started taking clomid or letrozole, they continue for 5 days, and 4 days thereafter the woman may return to the office for monitoring and blood work. Increase dosing if no follicles are growing or switch to gonadotropins if no follicles are growing and the patient has reached the maximum dose for clomid mg or letrozole 7.
Continue waiting if the cycle looks promising. We need to be able to maximize chances for pregnancy with ovarian stimulation cycles for intrauterine insemination — while at the same time having very low preferably zero rates of triplets and higher order pregnancies. There have been many studies done over the years that have investigated some of these important issues.
Results have varied, and study sizes were often limited. This study looks at these issues again with a very large group of infertile couples.
Pregnancy was unrelated to estrogen E2 level, E2 levels per follicle, or patient age. The HMG pregnancies included 20 Pregnancy was additionally related to E2 levels, but not to E2 levels per follicle, and was negatively related to age. When values were above these critical levels, triplet and higher-order implantations occurred in 2.
In clomiphene cycles, triple implantation occurred in 3. For patients age 35 and older, withholding HCG under the same circumstances may decrease pregnancy rates by half without significantly reducing multiple implantations. Comments about the study by Dr. Sherbahn : Triplet and higher-order pregnancies are to be avoided as much as possible.
Infertility specialists and patients both should be very careful when considering treatment options, and when deciding whether to proceed with an IUI cycle — or cancel it — when several follicles are present on ultrasound. This is a good and needed study in our field. Although other studies have investigated similar issues, this study was large and fairly well controlled, as well as prospective looking at what happens in the future, after the study is designed, rather than looking at patient charts to see what happened in the past.
Women under 35 were at high risk for multiples when there were six or more follicles 12 mm or more in diameter. However, for women over 35, the pregnancy rate was improved when there were six or more follicles in that size range, without significantly increasing the multiple implantation rate. We need to be careful about this. Sayre, Pennsylvania. Radiation Oncology. New York. Internal Medicine. Cleveland Clinic Florida, Concierge Medicine.
Vero Beach, Florida. Surgery, General.
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