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