Department of Obstetrics and Gynecology, Assisted Reproduction Technology Centre, CHU Sainte-Justine.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Quebec, Canada.
Curr Opin Obstet Gynecol. 2022 Jun 1;34(3):101-106. doi: 10.1097/GCO.0000000000000777. Epub 2022 Feb 25.
Although elective single embryo transfer has significantly reduced, the rate of multiple pregnancy in IVF cycles, this rate is still relatively high in gonadotropin-insemination cycles. Patients who fail to ovulate or to conceive with oral agents and have constraints for IVF are usually candidates for gonadotropin injections. The current review article provides an up-to-date summation of the different strategies that can be adopted to reduce the risk of multiple pregnancies in gonadotropin-stimulated intrauterine insemination cycles.
Gonadotropin-insemination treatments should be used judiciously by experienced providers. One should always start with the lowest effective gonadotropin dose (∼37.5 IU), monitor closely the ovarian response, and consider cycle cancellation or conversion to IVF whenever a high response is encountered. Therefore, every infertility practice should define its own cancellation and 'rescue IVF' criteria depending on the number of mature ovarian follicles and the age of the female partner.
These preventive measures amongst others should mitigate the risk of multiple pregnancies that can arise from gonadotropin-insemination cycles.
虽然体外受精（IVF）周期中选择性单胚胎移植已显著降低多胎妊娠率，但在促性腺激素诱导排卵周期中，多胎妊娠率仍相对较高。对于那些无法通过口服药物排卵或妊娠，且对 IVF 有限制的患者，通常是促性腺激素注射的候选者。本文综述了目前可用于降低促性腺激素诱导宫内授精周期多胎妊娠风险的不同策略。
促性腺激素诱导排卵治疗应由有经验的医生谨慎使用。医生应始终从最低有效剂量的促性腺激素（约 37.5IU）开始，密切监测卵巢反应，并在遇到高反应时考虑取消周期或转换为 IVF。因此，每个不孕不育实践都应根据成熟卵泡的数量和女性伴侣的年龄来定义自己的取消和“抢救性 IVF”标准。
除其他措施外，这些预防措施应可降低促性腺激素诱导排卵周期中多胎妊娠的风险。
