Does empiric superovulation improve fecundity in healthy women undergoing therapeutic donor insemination without a male partner?

Empiric superovulation does not improve fecundity in healthy women undergoing donor insemination. After three cycles of unmedicated inseminations, crossover to medication was associated with improvement in pregnancy rate.

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Volume 113, Issue 1, Pages 114–120

Authors:

Leah Hawkins Bressler, M.D., M.P.H., Brittany Papworth, M.D., Sarah Moustafa, M.D., Audrey Chang, B.A., Jennifer E. Mersereau, M.D., M.S.C.I.

Abstract:

Objective

To evaluate whether superovulation improves fecundity in women undergoing therapeutic donor insemination (TDI).

Design

Retrospective cohort study.

Setting

University-affiliated fertility clinic.

Patient(s)

Healthy women aged 23–45 years with no history of or risk factors for infertility who underwent 152 medicated and 104 unmedicated TDI cycles from 2013 to 2018.

Intervention

Unmedicated TDI versus use of medication in a TDI cycle (clomiphene citrate or letrozole).

Main Outcome Measure(s)

Cumulative probability of pregnancy in six TDI cycles.

Result(s)

In adjusted all-cycle analysis, medicated TDI cycles were less likely to result in pregnancy compared with unmedicated cycles. The incidence of twins was 23% in the medicated group and 0% in the unmedicated group. Medicated cycles were less likely to result in pregnancy in women younger than 40 years or with an antimüllerian hormone (AMH) level >1.2. After three cycles not resulting in pregnancy, the only women who conceived were those who crossed over from an unmedicated to a medicated cycle (12% vs. 0%).

Conclusion(s)

Patients undergoing unmedicated TDI cycles had higher fecundity and no incidence of twin gestations. Older women, those with low AMH, and those who fail to conceive after three unmedicated cycles may benefit from medication.


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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

3 Comments

Go to the profile of Emily Barnard
Emily Barnard 4 months ago

Congratulations to the authors on a great paper! Your article was selected for a #tweetorial this week by the Fertility and Sterility Interactive Associates. We would love to continue the conversation on Twitter with you! 

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Emily Barnard 4 months ago

#Tweetorial Link

Go to the profile of Marine Poulain
Marine Poulain 4 months ago

Dear authors, thank you for this great retrospective study. This is a really important question considering that patient are not considered as infertile. Regarding the high risk of twins in the medicated group, do you have any data on the psychological impact of a multiple versus single pregnancy in the group of single women using ART?