Q: Is there any reliable way to avoid higher order multiples with an IUI with injectables?
A: According to Dr. Robert Stillman, Medical Director of Shady Grove Fertility Center and Professor of Medicine at Georgetown Medical School, the answer is no. You can of course monitor through ultrasound and cancel a cycle if too many eggs mature, but many women are hesitant to go forward knowing that they may well have to cancel the cycle. IUI with injectable ovulation stimulating drugs are the primary source for higher order multiple births (triplets and up). Dr. Stillman said that the ASRM and SART have not issued guidelines for how to safely do this procedure because they don’t exist. There are too many variables to accurately predict how many eggs will mature the first time. Dr. Stillman recommends being prepared to either cancel the cycle if more than a few eggs are produced, or convert the cycle to an IVF cycle. Of course, this answer does not take into account the very real possibility that the reason a couple is doing IUI with injectables in the first place is that they either can’t afford an IVF cycle or have ethical objections to IVF. In many ways, these couples are between a rock and a hard place. To hear Dr. Stillman’s full response, listen to the Creating a Family show on reducing multiple births.Image Credit: Homeandgardners
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