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Do same sex couples and single women undergoing ovulation induction with oral agents and intrauterine insemination have outcomes comparable to infertile heterosexual couples?

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American Society for Reproductive Medicine 2017 Scientific Congress & Expo
October 28 to November 1, 2017 San Antonio, TX, USA
Title
DO SAME SEX COUPLES AND SINGLE WOMEN UNDERGOING OVULATION
INDUCTION WITH ORAL AGENTS AND INTRAUTERINE INSEMINATION HAVE
OUTCOMES COMPARABLE TO INFERTILE HETEROSEXUAL COUPLES?
Authors
T.G. Nazem1,2; S. Chang1,2; L. Sekhon1,2; J.A. Lee1; D. Gounko1; A.B. Copperman1,2 B.
McAvey1,3
Affiliations
1. Reproductive Medicine Associates of New York, 635 Madison Ave. 10th Floor New
York, NY, United States, 10022
2. Department of Obstetrics and Gynecology and Reproductive Science, Mount Sinai
School of Medicine, Klingenstein Pavilion, 9th Floor 1176 Fifth Ave. New York, NY,
United States, 10029
3. Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai
West, 1000 10th Ave. 10th Floor, New York, New York, United States, 10019
Objective
Although most same sex (SS) couples and single women do not have a medical diagnosis of
infertility, fertility treatments are needed to achieve their goal of childbearing. In fact, SS couples
and single women are treated similarly to infertile couples. The study sought to compare whether
a difference in outcome was found when comparing SS couples and single women to
heterosexual couples that undergo ovulation induction (OI) with oral agents and intrauterine
insemination (IUI) using cryopreserved sperm.
Design
Retrospective cohort study
Materials and Methods
The study included patients who underwent OI with clomiphene citrate or letrozole and
subsequent IUI between 2002 and 2017. Patients were segregated into two groups: SS/single
women and women with male partners. Patient age, BMI, ovarian reserve testing, sperm source
(donor or intimate partner), and number of mature follicles and endometrial thickness at time of
trigger were recorded. All sperm samples were previously cryopreserved. Data was analyzed
using chi square, fisher’s exact test, student’s t-test and multivariate logistic regression. The
study had 80% power to detect a 6% difference in implantation rate (IR) (sample size required
460 per group) assuming a baseline IR of 9%.
Results
A total of 460 SS or single women and 570 women with male partners underwent OI/IUI. SS and
single women had a lower day 3 FSH (7.74 ± 3.0 vs 8.19 ± 3.4, p=0.049) and lower total number
of mature follicles (1.69 ± 0.86 vs. 1.82 ± 0.92, p=0.02) compared to women with male partners.
Age, BMI, and oral OI agent used were similar between groups. There was no significant
difference in implantation (OR 1.23, 95%CI 0.7-2.2), ongoing pregnancy (OR 1.43, 95%CI 0.8-
2.7), multiple gestation rate (OR 1.94, 95%CI 0.27-13.9) or clinical pregnancy loss rate (OR
0.57, 95%CI 0.12-2.7) between the groups after adjusting for confounders.
Conclusions
SS couples/single women and infertile heterosexual couples have similar pregnancy outcomes
after OI/IUI cycles. As a means to enhance fertility rates in women of advancing age undergoing
donor IUI, oral OI agents may be utilized to achieve superovulation without increasing risk of a
multiple gestation pregnancy. Given the societal and biological barriers SS and single women
face in reaching their goal of childbearing, early access to reproductive care may facilitate
improved pregnancy outcomes. Providers may help empower SS and single women to initiate
care through community outreach and education about reproductive options.
Support
None.
Table 1. Patient Demographics and Cycle Characteristics and Outcomes
Same Sex/Single
Women (n=460)
Women with Male
Partner (n=570)
P Value
Age (y)
37.7 ± 4.2
38.1 ± 4.5
NS
BMI (kg/m2)
25.6 ± 5.4
25.8 ± 5.5
NS
Day 3 FSH (IU/mL)
7.74 ± 3.0
8.19 ± 3.4
0.049
Anti-mullerian
Hormone (pmol/L)
2.91 ± 3.3
2.39 ± 2.7
NS
Basal Antral Follicle
Count
11.6 ± 6.9
11.2 ± 8.4
NS
Gravidity
0.58 ± 1.0
0.79 ± 1.1
0.03
Parity
0.16 ± 0.43
0.20 ± 0.5
NS
Endometrial
Thickness at time of
Trigger (mm)
8.63 ± 1.6
8.64 ± 1.4
NS
Total Number Mature
Follicles at time of
Trigger
1.69 ± 0.86
1.82 ± 0.92
0.02
Clomid Use
68.9% (310/460)
69.1% (394/570)
NS
Letrozole Use
32.6% (150/460)
30.9% (176/570)
NS
Implantation Rate
10.4% (48/460)
10.0% (57/570)
NS
Ongoing Pregnancy
Rate
7.2% (33/460)
7.5% (43/570)
NS
Clinical Pregnancy
Loss Rate
31.3% (15/48)
24.6% (14/57)
NS
Multiple Gestation
Rate
8.3% (4/48)
10.5% (6/57)
NS
... Importantly, the oldest woman included in this study was 39 years old. A separate study comparing same-sex or unpartnered women undergoing ovulation induction/IUI to heterosexual couples with any infertility diagnosis also found that both groups had similar pregnancy outcomes (Nazem et al., 2017). In this study, it was not specified whether the heterosexual couples were seeking ART due to male factor, female factor or unexplained infertility. ...
Article
Full-text available
STUDY QUESTION Do women ≥40 years old without a male partner who utilize donor sperm have the same reproductive outcomes as those who utilize their partner’s sperm? SUMMARY ANSWER After controlling for relevant confounders, women ≥40 years old using donor sperm for IVF have significantly higher odds of having a live birth compared to those utilizing their partner’s sperm. WHAT IS KNOWN ALREADY Women who are unpartnered or in same-sex relationships are by definition not infertile, but may choose to conceive using donor sperm. It is not known how IVF outcomes are affected with the use of donor sperm compared to women utilizing their partner’s sperm, particularly at very advanced maternal ages. STUDY DESIGN, SIZE, DURATION This is a retrospective cohort study conducted at a university-affiliated center of women undergoing IVF with fresh embryo transfer between 2008 and 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients were divided into two groups based on the ejaculated sperm source utilized: donor or partner sperm. Live birth rate was the primary outcome. Pregnancy rate was the secondary outcome. Multivariable logistic regression was performed and adjusted for age, the developmental stage of the embryo, and the number of embryos transferred. Unadjusted odds ratio (OR) and adjusted OR (aOR) with 95% CI for pregnancy and live birth were estimated. Statistical significance was denoted by P < 0.05. MAIN RESULTS AND THE ROLE OF CHANCE A total of 3910 cycles in women ≥40 years old were analyzed, of which 307 utilized donor sperm and 3603 utilized their partner’s sperm to conceive. In the univariate analysis, patients utilizing donor sperm were found to have similar pregnancy rates as those utilizing partner sperm (41.0 vs 39.8%, OR: 0.95, 95% CI: 0.75–1.20). After adjusting for age, the number of embryos transferred and the developmental stage of the embryos, the model estimates did not vary (aOR: 1.22, 95% CI: 0.95–1.56). Similarly, the univariate analysis for live birth did not demonstrate a difference between groups (19.2 vs 17.8%, OR: 0.91, 95% CI: 0.67–1.22). However, after a similar adjustment was made for confounders, the use of donor sperm was associated with statistically significant increased odds of live birth (aOR: 1.38, 95% CI: 1.01–1.88). LIMITATIONS, REASONS FOR CAUTION As with any retrospective study, the potential for residual confounding exists, despite attempts to control for this with regression modeling. WIDER IMPLICATIONS OF THE FINDINGS Women ≥40 years old who are unpartnered or in same-sex relationships can be counseled that their odds of a live birth are slightly better than women in heterosexual relationships utilizing their partner’s sperm. These findings serve to further refine and individualize counseling on the expected IVF outcomes for women in this population. STUDY FUNDING/COMPETING INTEREST(S) No funding was sought for this study. The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
Article
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Background Asthma has been linked with prolonged time to pregnancy compared to healthy controls, also asthma has been linked to a higher need for fertility treatment. However, knowledge of the possible association between allergy and need for fertility treatment is limited. Our aim was to explore a possible difference in having had fertility treatment in women with asthma and live births in those with perennial allergy (animals, fungi and dust mites) compared to no allergy/seasonal allergy. The primary outcome of interest was fertility treatment. Patients and Methods Women enrolled in the Management of Asthma during Pregnancy (MAP) program at Hvidovre Hospital, DK, were included in the present analysis provided they fulfilled the following criteria: 1) diagnosed with asthma and current anti-asthma therapy and 2) first visit to the respiratory outpatient clinic within the first 18 weeks of pregnancy. Participants were divided into two groups: asthma with perennial allergy (cases) and asthma with seasonal/no allergy (controls). Logistic regression analysis was applied, and findings expressed as odds ratios (OR). Results Among women with asthma and perennial allergy (n=544 cases), 13.8% (n=75) had fertility treatment, compared to only 10.1% (n=39) among women with asthma and seasonal/no allergy (n=388, controls) (OR 1.43, 95% CI 0.95–2.16, p=0.087). This association remained statistically insignificant after adjusting for confounders, including BMI (OR 1.19, 95% CI 0.77–1.84, p=0.433). In women ≥35 years of age, 28% (n=44) and 20% (n=19), respectively, among cases and controls had fertility treatment (OR 1.60, 95% CI 0.87–2.94, p=0.132), and likewise, statistically insignificant after adjusting for confounders (OR 1.41, 95% CI 0.74–2.69, p<0.293). Conclusion In women with asthma and live births, our study revealed a trend towards an association between perennial allergy and a higher need for fertility treatment compared to seasonal/no allergy.
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