Evolution of gender options in multiple pregnancy management

Evans, Mark I.; Rosner, Mara; Andriole, Stephanie; Alkalay, Avishai; Gebb, Juliana; Britt, David W.

doi:10.1002/pd.4167

Cited by 15 publications

(18 citation statements)

References 32 publications

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“…There is the potential for DCDA twins and rarely dichorionic-triamniotic triplets. In these circumstances, we have shown that in experienced hands, genetic diagnosis of multiples by chorionic villus sampling (CVS) with fetal reduction produces outcomes comparable to having a singleton in the first place [129][130][131][132] .…”

Section: Discussionmentioning

confidence: 99%

Re-Thinking Elective Single Embryo Transfer: Increased Risk of Monochorionic Twinning - A Systematic Review

Dziadosz

Evans²

2017

Fetal Diagn Ther

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Background/Objectives: Multiple pregnancies have tripled in the United States over the past 3 decades. Attributed to increasing maternal age at delivery but more so assisted reproductive technological advances, an effort has been made to decrease twinning through elective single embryo transfer. We sought to review and evaluate risks of monochorionic twinning as a predictable consequence of increasing utilization of elective single embryo transfer on perinatal outcomes. Primary outcomes included twinning rates, fetal anomalies, growth, preterm birth, and mortality. Secondary outcomes included neurological and pulmonary disability, intrauterine growth restriction, and congenital cardiac anomalies and twin-twin transfusion syndrome. Data sources: PubMed and Embase. Results: A total of 106 studies identified by systematic search met the inclusion criteria. The trend for lower numbers of embryos transferred has inadvertently led to an increase in monochorionic twinning. This is associated with worse outcomes compared to dichorionic twinning and singleton gestations for all outcomes studied. Discussion: Of great concern for monochorionic twins is the risk profile of significant morbidity and mortality. Transfer of 2 embryos should be considered to avoid higher risks inherent to the shared placental phenomena related to monochorionic twins.

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Section: Discussionmentioning

confidence: 99%

Re-Thinking Elective Single Embryo Transfer: Increased Risk of Monochorionic Twinning - A Systematic Review

Dziadosz

Evans²

2017

Fetal Diagn Ther

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“…Recently, we published data that show such requests now come from patients of all ethnic backgrounds and cultures [62]. When patients do have a gender preference, there is an equal preference for females as males.…”

Section: Modern Managementmentioning

confidence: 99%

“…When patients do have a gender preference, there is an equal preference for females as males. For patients reducing to twins, the overwhelming preference is for one of each; for those reducing to a singleton, it is essentially a 50/50 split (table 7) [62]. …”

Section: Modern Managementmentioning

confidence: 99%

“…They will then choose which of 4 categories concerning gender they prefer. The groups are (1) patients who want to know ‘everything', (2) those who want to know ‘nothing', (3) those who have no preference but want to know what they have kept (but not the reduced), and (4) those who, all things considered, do have a preference (but do not want to know the reduced fetus' or fetuses' genders) [62]. …”

Section: Modern Managementmentioning

confidence: 99%

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Fetal Reduction: 25 Years' Experience

2014

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Fetal reduction (FR) began in the 1980s to salvage the pregnancies of couples needing fertility therapy who were finally successful but with too many fetuses. Since then, it has gone from a rarity performed in only the highest risk situations to an integral fail-safe of infertility practice. Our understanding of the problems of multiple and premature births has increased - even twins carry 4-5 times more risk than singletons. Evaluation of fetuses before FR has permitted more intelligent choices and improved resultant outcomes. We now perform chorionic villus sampling in approximately 85% of cases, obtain fluorescent in situ hybridization (FISH) results overnight, and then perform FR the next day. Decisions about which to reduce prioritize anomalies, but now can include fetal gender in the decision process, as couples are now just as likely to want girls as boys. In Mendelian cases, sophisticated molecular analyses permit diagnoses before FR, and new uses such as paternity analysis can be performed. Ethical arguments have also evolved; as with many technologies in which the start was for only ‘life or death cases', FR has also moved into ‘quality of life' issues. FR of twins to a singleton now compromise about 30% of our cases.

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“…Those who have no preference but want to know what they've kept (but not the reduced), and 4. Those who, considering all other factors, do have a preference (but don't want to know the reduced fetus' or fetuses' genders) (Evans et al 2013a ).…”

Section: Modern Managementmentioning

confidence: 99%

Prenatal and Preimplantation Diagnosis

Galst¹,

Verp²

2015

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Evolution of gender options in multiple pregnancy management

Cited by 15 publications

References 32 publications

Re-Thinking Elective Single Embryo Transfer: Increased Risk of Monochorionic Twinning - A Systematic Review

Re-Thinking Elective Single Embryo Transfer: Increased Risk of Monochorionic Twinning - A Systematic Review

Fetal Reduction: 25 Years' Experience

Prenatal and Preimplantation Diagnosis

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