Ovulation induction outcomes: analysis of more than 1500 cycles

Abstract

OBJECTIVE: To evaluate the outcomes of a large cohort of patients undergoing ovulation induction cycles.DESIGN: A retrospective cohort study of 1525 ovulation induction cycles performed in 694 patients between August 1998 and December 2008.MATERIALS AND METHODS: Patients underwent ovulation induction cycles with gonadotropins then timed intercourse or intrauterine insemination. Clomiphene citrate or a GnRH antagonist were used in about 10% of the cycles. Strategies used to reduce multiple gestations included low gonadotropin doses, and cancellation in high risk patients for more than three follicles > 16 mm or high estradiol levels.RESULTS: Per cycle pregnancy rate was 12.4% with a per cycle live birth rate of 7.5%. There was a trend towards higher per cycle pregnancy rate and live birth rate in younger patients (P=.0002). Multiple pregnancy rate was 12.7% with 10.1% twins and 2.6% triplets. Miscarriage rate was 25.8%, after excluding biochemical pregnancies, with a trend towards decreased miscarriages in younger patients (P=.004). The use of a GnRH antagonist decreased the risk of miscarriage (AOR .26, 95% CI .07-.91). Patients with hypothalamic ovarian dysfunction were associated with the highest per cycle pregnancy rate and live birth rate of 37.5% (no miscarriages) followed by PCOS. The lowest per cycle live birth rates were in women with diminished ovarian reserve, recurrent miscarriages, and uterine myomas (2%). The birthweight of a singleton from a pregnancy with a vanishing twin (n=8) was significantly lower than the birthweight of a singleton without a vanishing twin (2882 gm vs 3250gm, P=.013).CONCLUSIONS: Reducing multiple pregnancy with ovulation induction remains an important and challenging goal although there are no strict universal guidelines. In this cohort of patients, the high order multiple pregnancy rate was limited to 2.6% by using certain strategies. Risks of multiple pregnancy include a lower birthweight of the surviving singleton originating from a twin pregnancy. OBJECTIVE: To evaluate the outcomes of a large cohort of patients undergoing ovulation induction cycles. DESIGN: A retrospective cohort study of 1525 ovulation induction cycles performed in 694 patients between August 1998 and December 2008. MATERIALS AND METHODS: Patients underwent ovulation induction cycles with gonadotropins then timed intercourse or intrauterine insemination. Clomiphene citrate or a GnRH antagonist were used in about 10% of the cycles. Strategies used to reduce multiple gestations included low gonadotropin doses, and cancellation in high risk patients for more than three follicles > 16 mm or high estradiol levels. RESULTS: Per cycle pregnancy rate was 12.4% with a per cycle live birth rate of 7.5%. There was a trend towards higher per cycle pregnancy rate and live birth rate in younger patients (P=.0002). Multiple pregnancy rate was 12.7% with 10.1% twins and 2.6% triplets. Miscarriage rate was 25.8%, after excluding biochemical pregnancies, with a trend towards decreased miscarriages in younger patients (P=.004). The use of a GnRH antagonist decreased the risk of miscarriage (AOR .26, 95% CI .07-.91). Patients with hypothalamic ovarian dysfunction were associated with the highest per cycle pregnancy rate and live birth rate of 37.5% (no miscarriages) followed by PCOS. The lowest per cycle live birth rates were in women with diminished ovarian reserve, recurrent miscarriages, and uterine myomas (2%). The birthweight of a singleton from a pregnancy with a vanishing twin (n=8) was significantly lower than the birthweight of a singleton without a vanishing twin (2882 gm vs 3250gm, P=.013). CONCLUSIONS: Reducing multiple pregnancy with ovulation induction remains an important and challenging goal although there are no strict universal guidelines. In this cohort of patients, the high order multiple pregnancy rate was limited to 2.6% by using certain strategies. Risks of multiple pregnancy include a lower birthweight of the surviving singleton originating from a twin pregnancy.