TY - JOUR
T1 - Association of uterine fibroids and pregnancy outcomes after ovarian stimulation–intrauterine insemination for unexplained infertility
AU - National Institute of Child Health and Human Development Reproductive Medicine Network
AU - Styer, Aaron K.
AU - Jin, Susan
AU - Liu, Dan
AU - Wang, Baisong
AU - Polotsky, Alex J.
AU - Christianson, Mindy S.
AU - Vitek, Wendy
AU - Engmann, Lawrence
AU - Hansen, Karl
AU - Wild, Robert
AU - Legro, Richard S.
AU - Coutifaris, Christos
AU - Alvero, Ruben
AU - Robinson, Randal D.
AU - Casson, Peter
AU - Christman, Gregory M.
AU - Christy, Alicia
AU - Diamond, Michael P.
AU - Eisenberg, Esther
AU - Zhang, Heping
AU - Santoro, Nanette
N1 - Funding Information:
Supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) grants for AMIGOS: U10 HD39005, U10 HD38992, U10 HD27049, U10 HD38998, U10 HD055942, HD055944, U10 HD055936, U10HD055925; PPCOSII: U10 HD27049, U10 HD38992, U10HD055925, U10 HD39005, U10 HD38998, U10 HD055936, U10 HD055942, U10 HD055944; and Clinical Research Scientist Program (CREST): R25HD075737. This research was made possible by funding by American Recovery and Reinvestment Act. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD or the National Institutes of Health.
Publisher Copyright:
© 2016 American Society for Reproductive Medicine
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Objective To investigate the association of non–cavity-distorting uterine fibroids and pregnancy outcomes after ovarian stimulation–intrauterine insemination (OS-IUI) in couples with unexplained infertility. Design Secondary analysis from a prospective, randomized, multicenter clinical trial investigating fertility outcomes after OS-IUI. Setting Reproductive Medicine Network clinical sites. Patient(s) Nine hundred couples with unexplained infertility who participated in the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial. Intervention(s) Participants were randomized to one of three arms (clomiphene citrate, letrozole, or gonadotropins), and treatment was continued for up to four cycles or until pregnancy was achieved. Main Outcomes Measure(s) Conception (serum hCG increase), clinical pregnancy (fetal cardiac activity), and live birth rates. Result(s) A total of 102/900 participants (11.3%) had at least one documented fibroid and a normal uterine cavity. Women with fibroids were older, more likely to be African American, had a greater uterine volume, lower serum antimüllerian hormone levels, and fewer antral follicles than women without fibroids. In conception cycles, clinical pregnancy rates were significantly lower in participants with fibroids than in those without uterine fibroids. Pregnancy loss before 12 weeks was more likely in African American women with fibroids compared with non-African American women with fibroids. There was no difference in conception and live birth rates in subjects with and without fibroids. Conclusion(s) No differences were observed in conception and live birth rates in women with non–cavity-distorting fibroids and those without fibroids. These findings provide reassurance that pregnancy success is not impacted in couples with non–cavity-distorting fibroids undergoing OS-IUI for unexplained infertility. Clinical Trial Registration Number NCT01044862.
AB - Objective To investigate the association of non–cavity-distorting uterine fibroids and pregnancy outcomes after ovarian stimulation–intrauterine insemination (OS-IUI) in couples with unexplained infertility. Design Secondary analysis from a prospective, randomized, multicenter clinical trial investigating fertility outcomes after OS-IUI. Setting Reproductive Medicine Network clinical sites. Patient(s) Nine hundred couples with unexplained infertility who participated in the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial. Intervention(s) Participants were randomized to one of three arms (clomiphene citrate, letrozole, or gonadotropins), and treatment was continued for up to four cycles or until pregnancy was achieved. Main Outcomes Measure(s) Conception (serum hCG increase), clinical pregnancy (fetal cardiac activity), and live birth rates. Result(s) A total of 102/900 participants (11.3%) had at least one documented fibroid and a normal uterine cavity. Women with fibroids were older, more likely to be African American, had a greater uterine volume, lower serum antimüllerian hormone levels, and fewer antral follicles than women without fibroids. In conception cycles, clinical pregnancy rates were significantly lower in participants with fibroids than in those without uterine fibroids. Pregnancy loss before 12 weeks was more likely in African American women with fibroids compared with non-African American women with fibroids. There was no difference in conception and live birth rates in subjects with and without fibroids. Conclusion(s) No differences were observed in conception and live birth rates in women with non–cavity-distorting fibroids and those without fibroids. These findings provide reassurance that pregnancy success is not impacted in couples with non–cavity-distorting fibroids undergoing OS-IUI for unexplained infertility. Clinical Trial Registration Number NCT01044862.
KW - Intrauterine insemination
KW - ovarian stimulation
KW - pregnancy
KW - unexplained infertility
KW - uterine fibroids
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U2 - 10.1016/j.fertnstert.2016.12.012
DO - 10.1016/j.fertnstert.2016.12.012
M3 - Article
C2 - 28089575
AN - SCOPUS:85009788801
SN - 0015-0282
VL - 107
SP - 756-762.e3
JO - Fertility and Sterility
JF - Fertility and Sterility
IS - 3
ER -