News: Getting a 'handle' on multiple pregnancies
High-order multiple pregnancies due to ovulation induction associated with intrauterine insemination can be kept at 2% or less without affecting chances for pregnancy.
The incidence of high-order multiple pregnancies (HOMPs) due to ovulation induction (OI) associated with intrauterine insemination can be kept at 2% or less without affecting the overall chances for pregnancy, according to a recent retrospective analysis of published studies.
The analysis indicates that risk factors for HOMPs include seven or more preovulatory follicles ≥10 –12 mm, estradiol (E2) concentration ≥1,000 pg/mL, early cycles of treatment, age <32 years, low body mass index (BMI), and use of donor sperm.
Thus, to keep the rate of HOMPs low, fertility experts should use clomiphene before gonadotrophins, use the lowest effective doses of gonadotrophins (37.5–75 IU) for 4 to 6 cycles or pulsatile GnRH in the initial 3 to 4 cycles, cancel cycles for more than three follicles >10–15 mm, and aspirate excess follicles. Other factors that keep the risk for HOMPs low include patient age ≥38 years, BMI ≥24 kg/m2 , when stimulation is started after cycle day 7 or after selection of a dominant (≥10 mm) follicle, and after the second cycle of OI.
Dickey RP. Strategies to reduce multiple pregnancies due to ovulation stimulation. Fertil Steril. 2009;91:1-17.
Balancing VTE and bleeding risks in gynecologic cancer surgeries
December 6th 2024A comprehensive analysis shows the benefits of thromboprophylaxis often outweigh the bleeding risks during gynecologic cancer procedures, though patient-specific risk factors are crucial for decision-making.
Read More
Expert consensus sheds light on diagnosis and management of vasa previa
December 5th 2024A recent review established guidelines for prenatal diagnosis and care of vasa previa, outlining its definition, screening and diagnosis, management, and timing of delivery in asymptomatic patients.
Read More
