Risk factors for multiple gestation in women undergoing intrauterine insemination with ovarian stimulation

Objective: To identify whether sperm characteristics after washing and/or o vulation induction cycle characteristics can predict the occurrence of mult iple conception in patients undergoing ovarian stimulation and IUI. Design: Retrospective study. Setting: A gynecology clinic and an andrology laboratory at a tertiary care facility. Patient(s): One hundred patients with single pregnancies and 22 patients wi th multiple pregnancies. Intervention(s): Patients underwent ovarian stimul ation and IUI with their partner's sperm. Main Outcome Measure(s): Relation of patient characteristics, ovarian stimu lation, and sperm characteristics after washing to the occurrence of multip le pregnancy. Result(s): The mean serum E-2 level on the day of hCG injection was signifi cantly higher in the multiple conception group, but the number of follicles was not. The total sperm count, total motile sperm count, and sperm motili ty after washing did not differ between the groups. However, couples with m ultiple pregnancies had sperm with a significantly higher amplitude of late ral head movement than couples with single pregnancies. A peak E-2 level of >583 pg/mL on the day of hCG injection and sperm with an ALH of >4 mu m af ter washing predicted the occurrence of multiple pregnancy. Conclusion(s): Sperm with an amplitude of lateral head movement of >4 mu m and a peak E-2 level of >583 pg/mL are significant risk factors for multipl e pregnancy in patients undergoing IUI. (Fertil Steril(R) 1999;72: 613-8. ( C) 1999 by American Society for Reproductive Medicine).