Background The incidence of multiple gestation after therapyfor infertility is especially high among women in whom ovulationis induced with gonadotropins. Whether the number of high-ordermultiple pregnancies (those with three or more fetuses) canbe reduced is not known.
Methods We analyzed data on 3347 consecutive treatment cyclesin 1494 infertile women, 441 of which resulted in pregnancy.The data collected included the peak serum estradiol concentration,the number of follicles 16 mm or larger in diameter, and thetotal number of follicles on the day of induction of ovulationwith human chorionic gonadotropin. Receiver-operating-characteristiccurves and ordinal logistic-regression analyses were used toidentify values that predicted multiple conceptions.
Results Among the 441 pregnancies, 314 resulted from the conceptionof singletons, 88 of twins, 22 of triplets, 10 of quadruplets,5 of quintuplets, and 2 of sextuplets. Neither the number offollicles 16 mm or larger nor peak serum estradiol concentrationsgreater than 2000 or 2500 pg per milliliter (7342 or 9178 pmolper liter) (the cutoff values currently in wide use) were significantlyassociated with the incidence of high-order multiple pregnancy.However, increasing total numbers of follicles and increasingpeak serum estradiol concentrations correlated significantlywith an increasing risk of high-order multiple pregnancy (P<0.001),as did younger age (P=0.008). The risk of high-order multiplepregnancy was significantly increased in women with a peak serumestradiol concentration of 1385 pg per milliliter (5084 pmolper liter) or higher (multivariate odds ratio, 1.9; 95 percentconfidence interval, 1.3 to 2.8) or with seven or more follicles(multivariate odds ratio, 2.1; 95 percent confidence interval,1.2 to 3.9) on the day of induction of ovulation.
Conclusions Gonadotropin stimulation that is less intensivethan is currently customary may reduce the incidence of high-ordermultiple pregnancy in infertile women, though only to a limitedextent and at the expense of overall pregnancy rates.
Source Information
From the Center for Human Reproduction–Illinois, Chicago (N.G., I.T.-K., V.K.); the Center for Human Reproduction–New York, New York (N.G., A.V.); the Foundation for Reproductive Medicine, Chicago (N.G., V.K.); the Departments of Preventive Medicine and Health Systems Management, Rush–Presbyterian–St. Luke's Medical Center, Chicago (D.M.O.); and the In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Barzilai Medical Center, Ben Gurion University, Ashkelon, Israel (I.T.-K.).
Address reprint requests to Dr. Gleicher at the Center for Human Reproduction–New York, 635 Madison Ave., New York, NY 10022, or at chrjournal{at}aol.com.
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