Multiple births

The adverse reactions associated with the menotropins include ovarian enlargement, hemoperitoneum (blood in the peritoneal cavity), abdominal discomfort, and febrile reactions. Urofollitropin administration may result in mild to moderate ovarian enlargement, abdominal discomfort, nausea, vomiting, breast tenderness, and irritation at the injection site Multiple births and birth defects have been reported with the use of both menotropins and urofollitropin. 

Before beginning therapy, be aware of the possibility of multiple births and birth defects. 

Lubiprostone (Amitiza) [Laxative] Uses Chronic idiopathic constipation in adults Action Selective Cl channel activator Dose Adults. 24 meg PO bid w/ food Contra Mechanical GI obst Caution [C, /-] Severe D, severe renal or mod-severe hepatic impair Disp Gel, caps meg SE N, HA, D, GI distention, abd pain EMS Monitor for signs of electrolyte disturbances and h5rpovolemia d/t D OD May cause severe D, hypovolemia, and abd pain/cramps give IV fluids Lutropin Alfa (Luveris) [Hormone] Uses Inf ility Action Recombinant LH Dose 75 Units SQ w/ 75—150 Units FSH, 2 s arate inj max 14 d Caution [X, /M] Contra Primary ovarian failure, uncontrolled thyroid/adrenal dysfxn, intracranial lesion, AUB, hormone-dqjendent GU tumor, ovarian cyst, PRG Disp Inj SE HA, N, ovarian h5rpCTstimulation synd, breast pain, ovarian cysts T risk of multiple births EMS None OD Unlikely to cause life-threatening Sxs... 

Gonadotropins are used to treat infertility in women with potentially functional ovaries who have not responded to other treatments. The therapy is designed to simulate the normal menstrual cycle as far as is practical. A common protocol is daily injections of menotropins for 9 to 12 days, until estradiol levels are equal to that in a normal woman, followed by a single dose of hCG to induce ovulation. Two problems with this treatment are risks of ovarian hyperstimulation and of multiple births. Ovarian hyperstimulation is characterized by sudden ovarian enlargement associated with an increase in vascular permeability and rapid accumulation of fluid in peritoneal, pleural, and pericardial cavities. To prevent such occurrences, ovarian development is monitored during treatment by ultrasound techniques and by measurements of serum levels of estradiol. 

Ovarian enlargement is the most common side effect of clomiphene use. The occurrence of multiple births following ovulation induction with clomiphene is 4 to 9% 90% of these multiple births are twins. Since clomiphene is teratogenic, therapy should be discontinued if there is a chance that conception has occurred. Rarely, irreversible ocular toxicities have been reported with clomiphene use. 

With multiple births comes multiples of the same age. Each person involved has his age adjusted in the same way. 

Reproductive toxicity Male or female reproductive system Decreased libido and impotence Infertility Interrupted pregnancy (abortion, fetal death, premature delivery) Infant death or childhood morbidity Altered sex ratio and multiple births Chromosome abnormalities and birth defects Childhood cancer... 

Ericson A, Kallen B, Aberg A. Use of multivitamins and folic acid in early pregnancy and multiple births in Sweden. Twin Res 2001 4(2) 63-6. 

Czeizel AE, Metneki J, Dudas I. Higher rate of multiple births after periconceptional vitamin supplementation. N Engl J Med 1994 330(23) 1687-8. 

Werler MM, Cragan JD, Wasserman CR, Shaw GM, Erickson JD, Mitchell AA. Multivitamin supplementation and multiple births. Am J Med Genet 1997 71(l) 93-6. 

Multiple births (x cur about lOOi- of the time with patients taking clomiphene. and hirth defects in 2 to y/r of live neu-boms. Va.somotor "hot llu.shcs" occur about 10% of the time, and abnomial enlargement of the ovaries about l-lfi. Abdominal discomfort should be di.scusscd imntediatcl) with the physician. 

This effect has become the basis of treating infertility in women. In fact, overstimulation of the ovaries occurs in about 8 % of cases that result in multiple births.4... 

Clomiphene is used primarily for treatment of female infertility due to anovulation. By increasing gonadotropin levels, primarily FSH, it enhances follicular recruitment. It is relatively inexpensive, orally active, and requires less extensive monitoring than do other treatment protocols. However, the drug may exhibit untoward effects, including ovarian hyperstimulation, increased incidence of multiple births, ovarian cysts, hot flashes, and blurred vision. In addition, clomiphene-induced cycles have a relatively high... 

Mode of action 4- feedback inhibition —>T FSH and LH —>t ovulation —> pregnancy 0 Use fertility drug ° Adverse effect t multiple births... 

Estrogen partial agonist synthetic used in infertility to induce ovulation. May result in multiple births. 

Menotropins (Pergonol) Menotropins are LH and FSH (purified from urine of postmenopausal women) which are administered intramuscularly for 9-12 days and followed by an injection of chorionic gonadotropin. Multiple births occur in 20% of menotropin-induced pregnancies. Ovarian hyperstimulation, hemoperitoneum, febrile reactions and arterial thromtoembolism are the most frequent undesirable effects. 

Clomid is an ovarian stimulant that promotes follicle maturation and ovulation. Many follicles can mature simultaneously, resulting in the increased possibility of multiple births. 

Iron deficiency is commonly caused by insufficient dietary intake, excessive menstrual flow, multiple births, and gastrointestinal bleeding (occult or patent) due to medications (aspirin, steroids), hiatal hernia, peptic ulcers, gastritis associated with alcoholism, anemia of chronic disease, geophagia, and tumors. After these patients are carefully diagnosed, iron supplementation is administered using oral ferrous sulfate or by intravenous therapy with an iron-dextran complex (Imferon) [28,29]. 

The trend is to transfer a single embryo to prevent multiple births. Multiple births—even twins—have a much higher incidence of complications. Embryos stored for ten to twelve years have been thawed with subsequent development of a live infant. The cost for freezing an embryo is around 700. Storage costs vary depending on the length of storage. 

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