TY - JOUR
T1 - Ovarian stimulation and intrauterine insemination at the quarter centennial
T2 - Implications for the multiple births epidemic
AU - McClamrock, Howard D.
AU - Jones, Howard W.
AU - Adashi, Eli Y.
PY - 2012/4
Y1 - 2012/4
N2 - 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 Finally, we posit that OS/IUI is not likely to be superseded by IVF absent further commoditization and thus greater affordability.
AB - 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 Finally, we posit that OS/IUI is not likely to be superseded by IVF absent further commoditization and thus greater affordability.
KW - Infertility
KW - intrauterine insemination
KW - multiple births
KW - ovarian stimulation
UR - http://www.scopus.com/inward/record.url?scp=84859124015&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84859124015&partnerID=8YFLogxK
U2 - 10.1016/j.fertnstert.2012.02.031
DO - 10.1016/j.fertnstert.2012.02.031
M3 - Review article
C2 - 22463774
AN - SCOPUS:84859124015
SN - 0015-0282
VL - 97
SP - 802
EP - 809
JO - Fertility and sterility
JF - Fertility and sterility
IS - 4
ER -