Prevention of multiple pregnancies in gonadotropin-insemination cycles.

Dahdouh EM, Zreik TG, Ghaname W, Garcia-Velasco JA, Balayla J
Curr Opin Obstet Gynecol. 2022 Jun 1;34(3):101-106. Epub 2022 Feb 25. 2022 doi: 10.1097/GCO.0000000000000777


Purpose of review: Although elective single embryo transfer has significantly reduced, the rate of multiple pregnancy in IVF cycles, this rate is still relatively high in gonadotropin-insemination cycles. Patients who fail to ovulate or to conceive with oral agents and have constraints for IVF are usually candidates for gonadotropin injections. The current review article provides an up-to-date summation of the different strategies that can be adopted to reduce the risk of multiple pregnancies in gonadotropin-stimulated intrauterine insemination cycles. Recent findings: Gonadotropin-insemination treatments should be used judiciously by experienced providers. One should always start with the lowest effective gonadotropin dose (_37.5 IU), monitor closely the ovarian response, and consider cycle cancellation or conversion to IVF whenever a high response is encountered. Therefore, every infertility practice should define its own cancellation and ‘rescue IVF’ criteria depending on the number of mature ovarian follicles and the age of the female partner. Summary: These preventive measures amongst others should mitigate the risk of multiple pregnancies that can arise from gonadotropin-insemination cycles.