Conversion of in vitro fertilization cycles to intrauterine inseminations in patients with a poor ovarian response: risk of multiple pregnancies - 11/06/20

Doi : 10.1016/j.jogoh.2020.101831

Caroline Verhaeghe ^a, Sarah Abnoun ^a, Pascale May-Panloup ^a, Romain Corroenne ^a, Guillaume Legendre ^a, Philippe Descamps ^a, Hady El Hachem ^b, Pierre-Emmanuel Bouet ^a,⁎
^a Department of Reproductive Medicine, Angers University Hospital, Angers, France
^b Department of Reproductive Medicine, Clemenceau Medical Center, Beirut, Lebanon

^⁎Corresponding author at: Department of Reproductive Medicine, Angers University Hospital, 4 rue Larrey, 49000 Angers, France.Department of Reproductive MedicineAngers University Hospital4 rue LarreyAngers49000France

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Abstract

Purpose

To determine the risk of multiple pregnancies (MP) following conversion of in vitro fertilization (IVF) cycles to intrauterine insemination (IUI) when a poor ovarian response (POR) is diagnosed during controlled ovarian stimulation (COS).

Methods

We undertook a retrospective study in our teaching hospital from January 2012 to December 2017. We included all IVF cycles with POR that were converted to IUI (<5 follicles 14 mm and peak estradiol level < 1000 pg/mL on trigger day).

Results

Overall, 205 IVF cycles that were converted to IUI in 128 patients were analyzed. Mean age was 34.1 ± 4.6 years, mean antral follicle count was 11 ± 5.3 and mean AMH was 1.8 ± 2.9 ng/L. The main causes of infertility were unexplained (41%) (84/205) and diminished ovarian reserve (35%) (72/205). Of all the cycles converted to IUI, 53 (26%) had one mature follicle on trigger day, 56 (27%) had 2, 56 (27%) had 3, and 40 (20%) had 4. The live birth rate (LBR) was 7.3% (15/205), and the miscarriage rate was 28.6% (6/21). There were 3 twin pregnancies, but no higher order pregnancies; the MP rate was 14.3% (3/21). There was no significant difference in the MP rate between patients with 1-2 mature follicles and patients with 3-4 mature follicles (18.2% vs 10%, p = 0.99, respectively).

Conclusion

In IVF cycles converted to IUI for poor response, the risk of MP is acceptable (14%) with no higher order pregnancies, even with 3 or 4 follicles ≥14 mm on trigger day.

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Abbreviations : AFC, AMH, BMI, COS, CPR, GA, ICSI, IU, IUF, IVF, LBR, MP, MPR, OATS, PGD, PGS, POR