Association of uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination for unexplained infertility

Aaron K. Styer; Susan Jin; Dan Liu; Baisong Wang; Alex J. Polotsky; Mindy S Christianson; Wendy Vitek; Lawrence Engmann; Karl Hansen; Robert Wild; Richard S. Legro; Christos Coutifaris; Ruben Alvero; Randal D. Robinson; Peter R. Casson; Gregory M Christman; Alicia Christy; Michael P Diamond; Esther Eisenberg; Heping Zhang; Nanette Santoro; National Institute of Child Health and Human Development Reproductive Medicine Network

doi:10.1016/j.fertnstert.2016.12.012

Association of uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination for unexplained infertility

Aaron K. Styer, Susan Jin, Dan Liu, Baisong Wang, Alex J. Polotsky, Mindy S Christianson, Wendy Vitek, Lawrence Engmann, Karl Hansen, Robert Wild, Richard S. Legro, Christos Coutifaris, Ruben Alvero, Randal D. Robinson, Peter R. Casson, Gregory M Christman, Alicia Christy, Michael P Diamond, Esther Eisenberg, Heping ZhangNanette Santoro, National Institute of Child Health and Human Development Reproductive Medicine Network

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

Abstract

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.

Original language	English (US)
Journal	Fertility and Sterility
Early online date	Jan 12 2017
DOIs	https://doi.org/10.1016/j.fertnstert.2016.12.012
State	E-pub ahead of print - Jan 12 2017
Externally published	Yes

Keywords

Intrauterine insemination
Ovarian stimulation
Pregnancy
Unexplained infertility
Uterine fibroids

ASJC Scopus subject areas

Reproductive Medicine
Obstetrics and Gynecology

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10.1016/j.fertnstert.2016.12.012

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Styer, A. K., Jin, S., Liu, D., Wang, B., Polotsky, A. J., Christianson, M. S., Vitek, W., Engmann, L., Hansen, K., Wild, R., Legro, R. S., Coutifaris, C., Alvero, R., Robinson, R. D., Casson, P. R., Christman, G. M., Christy, A., Diamond, M. P., Eisenberg, E., ... National Institute of Child Health and Human Development Reproductive Medicine Network (2017). Association of uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination for unexplained infertility. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2016.12.012

Styer, AK, Jin, S, Liu, D, Wang, B, Polotsky, AJ, Christianson, MS, Vitek, W, Engmann, L, Hansen, K, Wild, R, Legro, RS, Coutifaris, C, Alvero, R, Robinson, RD, Casson, PR, Christman, GM, Christy, A, Diamond, MP, Eisenberg, E, Zhang, H, Santoro, N & National Institute of Child Health and Human Development Reproductive Medicine Network 2017, 'Association of uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination for unexplained infertility', Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2016.12.012

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title = "Association of uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination for unexplained infertility",

abstract = "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 antim{\"u}llerian 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.",

keywords = "Intrauterine insemination, Ovarian stimulation, Pregnancy, Unexplained infertility, Uterine fibroids",

author = "Styer, {Aaron K.} and Susan Jin and Dan Liu and Baisong Wang and Polotsky, {Alex J.} and Christianson, {Mindy S} and Wendy Vitek and Lawrence Engmann and Karl Hansen and Robert Wild and Legro, {Richard S.} and Christos Coutifaris and Ruben Alvero and Robinson, {Randal D.} and Casson, {Peter R.} and Christman, {Gregory M} and Alicia Christy and Diamond, {Michael P} and Esther Eisenberg and Heping Zhang and Nanette Santoro and {National Institute of Child Health and Human Development Reproductive Medicine Network}",

year = "2017",

month = jan,

day = "12",

doi = "10.1016/j.fertnstert.2016.12.012",

language = "English (US)",

journal = "Fertility and Sterility",

issn = "0015-0282",

publisher = "Elsevier Inc.",

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T1 - Association of uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination for unexplained infertility

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 R.

AU - Christman, Gregory M

AU - Christy, Alicia

AU - Diamond, Michael P

AU - Eisenberg, Esther

AU - Zhang, Heping

AU - Santoro, Nanette

AU - National Institute of Child Health and Human Development Reproductive Medicine Network

PY - 2017/1/12

Y1 - 2017/1/12

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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Association of uterine fibroids and pregnancy outcomes after ovarian stimulation-intrauterine insemination for unexplained infertility

Abstract

Keywords

ASJC Scopus subject areas

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