Nezhat Moosavifar, Masoomeh Aliakbarzadeh, Mohammadtaghi Shakeri.
Association of the number of follicles of various sizes and treatment protocol with multiple pregnancies following ovulation induction and intrauterine insemination.
J Pak Med Assoc Jan ;58(1):18-22.

Objective: To find the relationship between the number of follicles of different sizes and the stimulation protocol to the probability of multiple pregnancies. Methods: Out of 2034 cycles of OI-IUI in a university based infertility center, between March 2003 to March 2006, there were 322 clinically pregnant cycles. The following variables were tabulated for each cycle: female age, treatment protocol, follicle number and size on the day of hCG administration and number of gestational sacs detected by transvaginal ultrasonography at 9 weeks of gestation. Ovulation induction was done by cc, cc+hMG or hMG. Follicles were categorized by size as = 18mm, =15mm and =12mm. To find the relationship between singleton and multiple pregnancy with the average number of follicles of different sizes and the protocol of treatment, a statistical analysis was performed. Results: There were 38 (11.8%) multiple pregnancies in 322 pregnant cycles. consisting of 26(8.1%) twin,11 (3.4%) triplet and 1 (0.3%) quintuplet. Multiple pregnancy rate in cc, cc+hMG and hMG cycles were 9.01%,12.2% and 15% respectively. There was no significant relationship between different treatment protocols and the risk of multiple pregnancy (p>0.1 ). The number of follicles > 12mm or > 15mm or > 18mm had significant relationship with single and multiple pregnancies (p<0.01), but the correlation coefficient was higher for > 18mm follicles. The mean age of the singleton and multiple pregnant women was not significantly different (p>0.1). Conclusions: The risk of multiple conceptions is related to > 18mm follicles in addition to the total number of follicles >12mm. Different protocol of ovulation induction revealed no relationship with the risk of multiple conceptions (JPMA 58:18;2008).

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