Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles

Abstract

Ovulation induction (OI) or ovulation enhancement (OE) with gonadotrophins can be a reasonable treatment option for patients with a variety of infertility diagnoses. It must be used with extensive monitoring and management given the risk of multiple pregnancy, especially high-order multiples. This retrospective study evaluated per cycle outcomes of a large cohort of 1452 gonadotrophin OI/OE cycles at an academic infertility centre, and the efficacy of specific guidelines in limiting multiple pregnancy. The lowest possible gonadotrophin doses were used and cycle cancellation was recommended if more than three dominant follicles were present, and/or if serum oestradiol was above 1500 pg/ml. Overall, pregnancy rate (PR) was 12% and live birth rate was 7.7%, with an increasing trend in younger patients ( P = 0.0002 and <0.0001, respectively). Multiple clinical PR was 2.6% with 1.9% twins and 0.7% triplets and above. The birthweight of a singleton from a vanishing twin pregnancy ( n = 8) was significantly lower than other singletons (2882 g versus 3250 g, P = 0.013). Reducing multiple pregnancies from OI/OE cycles remains an important and challenging goal. In this large cohort, high-order multiple clinical PR was limited to 0.7% per cycle by using specific management strategies while maintaining a reasonable PR. High-order multiple pregnancy and live birth may be limited with the use of certain management guidelines in gonadotrophin ovulation induction and enhancement cycles while maintaining a reasonable pregnancy rate. Those guidelines include using the lowest possible dose of gonadotrophins, and cycle cancellation if more than three dominant follicles are present and/or if the oestradiol concentration is >1500 pg/ml.