Gonadotropin ups risk of multiple gestation in women with unexplained fertility

In women undergoing intrauterine insemination after ovarian stimulation (OS-IUI) for the treatment of unexplained infertility, the use of gonadotropin vs other oral medications carries an increased risk of multiple gestation for every birth gained, as reported in a recent study.

Researchers conducted a systematic review and meta-analysis of studies comparing live birth and multiple gestation in patients who had been diagnosed with unexplained infertility and undergoing OS-IUI with oral medications (clomiphene and letrozole) vs gonadotropins.

The meta-analysis included eight trials involving a total of 2,989 patients undergoing 6,590 cycles. Use of gonadotropins led to a substantial increase in both live births and multiple gestations in one study, was associated with greater odds of live birth in two studies, and came with a higher likelihood of having twins in two studies.

The relative risk for live birth associated with receipt of gonadotropins was 1.09, while that for multiple gestation was 1.06. Clinical pregnancy was markedly higher in protocols with lax cancellation policies or higher gonadotropin doses, with corresponding relative risks for multiple gestations of 1.20 and 1.15. Singleton births per patient were comparable between the two groups.

The results were consistent in per-protocol, per cycle or fixed-effect model sensitivity analyses.

According to the researchers, the present study does not support the use of gonadotropin for OS-IUI in women with unexplained infertility.