Clomiphene citrate intrauterine insemination (IUI) before gonadotropin IUI affects the pregnancy rate and the rate of high-order multiple pregnancies

Abstract

Objective To determine if previous treatment with clomiphene citrate intrauterine insemination (CC-IUI) affects pregnancy and high-order multiple pregnancy (HOMP) rates in subsequent hMG-IUI or FSH-IUI cycles. Design Retrospective cohort study. Setting Private infertility clinic. Patient(s) Five hundred fifty-one patients (age <38 years) without tubal factor infertility, treated with 918 cycles of hMG/FSH-IUI after one or more unsuccessful cycles of CC-IUI; 908 patients treated with 1459 cycles of hMG/FSH-IUI without prior CC-IUI. Intervention(s) CC-IUI, hMG-IUI, FSH-IUI. Main outcome measure(s) Pregnancy rate per cycle, HOMP (three or more gestational sacs). Result(s) Pregnancy rates during the first three hMG-IUI or FSH-IUI cycles averaged 21.8 ± 1.1% without previous CC-IUI, 19.6 ± 1.3% after one to four cycles of CC-IUI, and 3.6 ± 2.6% after ≥ five previous CC-IUI cycles. The HOMP rates were 8.8% without previous CC-IUI, 7.5% after one, 5.7% after two and <2.6% (0 out of 38) after ≥ three previous CC-IUI cycles. Conclusion(s) Pregnancy rates in hMG/FSH-IUI cycles are significantly reduced after four unsuccessful CC-IUI cycles. High-order multiple pregnancies due to hMG/HMG-IUI are reduced following previous unsuccessful CC-IUI cycles.