A CONSERVATIVE TREATMENT PROTOCOL WITH HUMAN MENOPAUSAL GONADOTROPINSAIMED AT REDUCING MULTIPLE BIRTHS

In multicenter studies involving 3002 courses of human menopausal gona dotropins (hMG) therapy in 1286 patients, 20% of the patients who deli vered had multiple gestations; 75% of these were twins and 25% were tr iplets or higher parity. Our stimulation regimen is very conservative in that we 1) try to allow a female with LPD and regular cycles but no t reaching a mature follicle to first select her dominant follicle and wait until the serum E2 reaches approximately 100 pg/mL then add the hMG. With anovulatory women we frequently begin with only 75 IU hMG an d gradually increase the hMG dosage. Using this approach we have usual ly attained at least a 70% pregnancy rate in six months. A study was p erformed to see if this conservative approach resulted in a decreased multiple birth rate percentage especially with triplets or more. The s tudy was to evaluate the outcome of 241 consecutive pregnancies in whi ch hMG was the sole therapy. There were 203 with one gestation and 38 with multiples. Twins - 32; triplets - 6. Thus 15% (38/241) had multip le births; six of 38 (15%) of the multiples had triplets or more. Thou gh our multiple birth rate and especially higher parity rate appears t o be lower than average no statistical difference was found. Thus even with conservative use of hMG multiple births cannot be easily avoided .