TY - JOUR
T1 - Probability of Pregnancy with Mono vs Multiple Folliculogenesis in Women with Unexplained Infertility
AU - Plowden, Torie C.
AU - Mumford, Sunni L.
AU - Wild, Robert A.
AU - Cedars, Marcelle I.
AU - Steiner, Anne Z.
AU - Franasiak, Jason M.
AU - Diamond, Michael P.
AU - Santoro, Nanette
N1 - Publisher Copyright:
© 2022 Published by Oxford University Press on behalf of the Endocrine Society.
PY - 2023/1
Y1 - 2023/1
N2 - Context: Ovarian stimulation (OS) increases pregnancy rates but can cause multiple folliculogenesis and multiple pregnancy. Objective: To determine whether the probability of pregnancy differs in OS cycles with mono-vs multifolliculogenesis in women with unexplained infertility (UI). Design: Secondary analysis of a multicenter, randomized controlled trial: Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation with 3 treatment arms: gonadotropins, clomiphene, or letrozole, combined with intrauterine insemination. Women were categorized as having either 1 or ≥ 2 mature follicles (≥ 16mm). Relative risk (RR) and 95% CIs for clinical pregnancy and live birth by number of follicles were estimated using generalized linear models adjusted for age, body mass index, years of infertility, and history of prior live birth. Setting: 12 US-based clinical sites. Participants: Normally cycling women aged 18 to 40 years with a normal uterine cavity and at least 1 patent fallopian tube. Male partners with ≥ 5 million total motile sperm. Interventions: Gonadotropins, clomiphene, or letrozole with insemination Main Outcome Measure(s): Clinical pregnancy rates (CPR) and live birth rates (LBR). Results: A single mature follicle > 16mm resulted in lower CPR (RR, 0.70; 95% CI, 0.54-0.90) and LBR (RR, 0.67; 95% CI, 0.51-0.89) compared with ≥ 2 mature follicles. When stratified by treatment modality, no association of follicle number with CPR or LBR was observed for letrozole or clomiphene, but women using gonadotropins had lower CPR and LBR with monofolliculogenesis. Conclusion: In couples undergoing gonadotropin treatment for UI, monofolliculogenesis following OS is related to a lower rate of live birth.
AB - Context: Ovarian stimulation (OS) increases pregnancy rates but can cause multiple folliculogenesis and multiple pregnancy. Objective: To determine whether the probability of pregnancy differs in OS cycles with mono-vs multifolliculogenesis in women with unexplained infertility (UI). Design: Secondary analysis of a multicenter, randomized controlled trial: Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation with 3 treatment arms: gonadotropins, clomiphene, or letrozole, combined with intrauterine insemination. Women were categorized as having either 1 or ≥ 2 mature follicles (≥ 16mm). Relative risk (RR) and 95% CIs for clinical pregnancy and live birth by number of follicles were estimated using generalized linear models adjusted for age, body mass index, years of infertility, and history of prior live birth. Setting: 12 US-based clinical sites. Participants: Normally cycling women aged 18 to 40 years with a normal uterine cavity and at least 1 patent fallopian tube. Male partners with ≥ 5 million total motile sperm. Interventions: Gonadotropins, clomiphene, or letrozole with insemination Main Outcome Measure(s): Clinical pregnancy rates (CPR) and live birth rates (LBR). Results: A single mature follicle > 16mm resulted in lower CPR (RR, 0.70; 95% CI, 0.54-0.90) and LBR (RR, 0.67; 95% CI, 0.51-0.89) compared with ≥ 2 mature follicles. When stratified by treatment modality, no association of follicle number with CPR or LBR was observed for letrozole or clomiphene, but women using gonadotropins had lower CPR and LBR with monofolliculogenesis. Conclusion: In couples undergoing gonadotropin treatment for UI, monofolliculogenesis following OS is related to a lower rate of live birth.
KW - folliculogenesis
KW - gonadotropin
KW - single dominant follicle
KW - unexplained infertility
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U2 - 10.1210/jendso/bvac142
DO - 10.1210/jendso/bvac142
M3 - Article
AN - SCOPUS:85154535683
SN - 2472-1972
VL - 7
JO - Journal of the Endocrine Society
JF - Journal of the Endocrine Society
IS - 1
M1 - bvac142
ER -