Embryo reduction: our experience

Abstract

This increase in multifoetal pregnancy has been from 1.25% in spontaneous pregnancies to 5-8% with clomiphene induced cycles 1,2 and is nearly 30% in patients using exogenous gonadotrophins for super ovulation for sub-fertility. [3][4][5][6] Various measures have been taken to reduce the incidence of multifoetal gestation by making single embryo transfer the norm. 7,8 Multiple pregnancies being high-risk pregnancies are frequently complicated by preterm delivery, low birth weight, preeclampsia and increased perinatal morbidity and mortality. 9,10 Such patients also require more operative interference and prolonged hospital stay for both the mother and the preterm baby thus mounting hospital expenditures.Multifoetal pregnancy reduction, although a well tried technique for preventing the above complications, is a difficult choice for the couples in anguish, to make or agree upon.11 Two-third of the couples who have to undergo this procedure suffer from acute emotional pain, stress, fear, and 20% have a feeling of guilt and anger.12 Therefore adequate counselling is a must before undertaking this procedure.With this primary aim of preventing the myriad complications associated with multifoetal gestation, a policy was adopted at our centre to reduce the higher order pregnancies to a twin gestation.Multifoetal pregnancy reduction can be carried out both transvaginally and transabdominally under ultrasound guidance after proper patient selection and pre-operative counselling. 9,13 Therefore this study was carried out to assess the efficacy of multifoetal pregnancy reduction by transvaginal route, the procedure exclusively carried out at our centre. MATERIALS AND METHODFour thousand four hundred and ninety nine in-vitro fertilisation (IVF) and 7142 intrauterine insemination (IUI) cycles were carried out at this centre till December 2009 with successful outcome in 1630 IVF cycles and 1421 IUI procedures. Embryo reduction was carried out in 52 cases of triplets or higher order pregnancies.Out of the above, 49 patients had triplet pregnancy, two had quadruplet pregnancies, and one quintuplet pregnancy which resulted from IUI. Multifoetal pregnancy reduction was carried out with aim of having two live foetuses after the procedure. Being IVF pregnancies these were diagnosed very early, at 5-6 weeks of gestation. All the patients were offered luteal support with micronized progesterone. Patient and relatives were counselled and preanaesthetic check-up was carried out. Each patient was informed about the potential risks of the technique and written consent was obtained before the procedure was carried out.

Comparing the effect of gonadotropin-releasing hormone agonist and human chorionic gonadotropin on final oocytes for ovulation triggering among infertile women undergoing intrauterine insemination: An RCT

“…There were two cases of triple and quintuplet pregnancies in GnRH-a group and 2 abortions in HCG group. Two cases of high multiple pregnancies went under embryo reduction in the eighth week of pregnancy, and in both cases, healthy twins were delivered in 38 th wk of pregnancy ( 12 ). Although the implantation rate in the HCG group (36.53%) was higher than in the GnRH-a group (32.93%), this difference was not statistically significant.…”

The consequences of fetal reduction for quintuplets after ICSI-ET

“…The contents of the gestational sac were not aspirated. 14 Embryo reduction since it is undertaken at very early gestational age and embryos are aspirated, there may not be any fetus papyraeceae and this may also prevent some of the complications of higher order pregnancies.…”

Multifetal Pregnancy Reduction in Quadruplets: Perinatal Outcome—Analysis of 20 Consecutive Cases

“…MFPR can be carried out abdominally at 11-14 weeks and vaginally at 7 to 8 weeks [5,10]. Historically many different techniques have been described in the literature like mechanical disruption, air embolisation, electrocautery etc.…”

“…To reduce the complications associated with HOMP, especially the risk of prematurity and its consequences, multifetal pregnancy reduction (MFPR) has long been advised. This is a well-established technique to reduce the complications of HOMP by converting them into twins or sometimes into singletons [5,6]. The outcome after MFPR may be as good as unreduced twins [6][7][8].…”