Prevention of multiple pregnancy during ovulation induction

Area of Science:

• Reproductive Endocrinology
• Infertility Treatment
• Maternal-Fetal Medicine

Background:

• Gonadotrophin ovulation induction is a common treatment for various ovulation disorders and unexplained infertility.
• High rates of multiple pregnancies, exceeding 30% in the US, are associated with ovulation induction, particularly after controlled ovarian hyperstimulation and intrauterine insemination.
• The incidence of multiple pregnancies poses significant risks to both maternal and fetal health.

Purpose of the Study:

• To review current strategies for reducing multiple pregnancies resulting from ovulation induction.
• To highlight the need for evidence-based guidelines and robust clinical trials to minimize higher-order multiple pregnancies.
• To ensure that interventions do not compromise couples' chances of conception.

Main Methods:

• Review of existing literature on ovulation induction and multiple pregnancy reduction techniques.
• Analysis of current treatment strategies, including cancellation policies, follicle reduction, and conversion to in vitro fertilization (IVF).
• Discussion of multifetal pregnancy reduction as a management option for established multiple gestations.

Main Results:

• Multiple pregnancy rates following gonadotrophin ovulation induction can exceed 30% in the United States.
• Several methods exist to reduce multiple follicular development and ovulation, such as aggressive cancellation, follicle aspiration, or IVF conversion.
• Multifetal pregnancy reduction is an available option for managing existing multiple gestations.

Conclusions:

• Effective procedures are available to reduce the incidence of multiple pregnancies after ovulation induction.
• There is a critical need for well-designed clinical trials and treatment guidelines.
• The goal is to substantially reduce or eliminate higher-order multiple pregnancies without compromising fertility treatment success.