The particular problems of ambulatory controlled ovarian stimulation

The impact of infertility treatments on the frequency of multiple pregnancies in France was investigated using data on total multiple deliveries and multiple deliveries from assisted reproduction and intrauterine insemination (IUI) between 1994 and 2004, and by making assumptions about the expected rate of natural multiple deliveries. During this period, 72.0% of multiple deliveries were the result of infertility treatments. The rate of triplet delivery after assisted reproduction decreased by 50% between 2000 and 2004, despite a large increase in deliveries resulting from assisted reproduction. In 2004, assisted reproduction techniques accounted for 23.6% of all triplets delivered and for 34.9% of those delivered after infertility treatments. The corresponding figures for IUI were 12.2% and 18.0% respectively, with a doubling since 1996; for ovulation induction without IUI the corresponding figures were 27.7% and 37.9% respectively. The figures for ovulation induction are slightly higher than for assisted reproduction treatment, probably due to the high number of quadruplets and higher order deliveries in this group. However, no conclusion can be drawn on the relative contribution of increased risk for a given ovarian stimulation cycle on one hand and of a simple increase in the number of treated cycles on the other, since no surveillance data to distinguish between them exists in France. There is a real need for more investigation on ovulation induction in France.