Evolving trends in 2000 cases of multifetal pregnancy reduction: a single-center experience

Stone, Joanne; Belogolovkin, Victoria; Matho, Andrea; Berkowitz, Richard L.; Moshier, Erin; Eddleman, Keith

doi:10.1016/j.ajog.2007.06.056

Cited by 35 publications

(20 citation statements)

References 14 publications

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“…However, the increased risk for multiple pregnancy associated with gonadotropin treatment cannot be eliminated entirely, and even the low-dose gonadotropin regimens advocated here are associated with five-to 10-fold increased risk (54). Although multifetal pregnancy reduction can be offered when treatment results in a high-order multiple pregnancy (triplets or greater), the risk is easier to avoid than to manage (55).…”

Section: Complications In Oimentioning

confidence: 97%

Use of exogenous gonadotropins in anovulatory women: a technical bulletin

2008

Fertility and Sterility

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Section: Complications In Oimentioning

confidence: 97%

Use of exogenous gonadotropins in anovulatory women: a technical bulletin

2008

Fertility and Sterility

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“…and ''where such pregnancies arise, it may be considered ethically preferable to reduce the number of fetuses rather than to do nothing'' [FIGO, 2006]. Multifetal pregnancy reduction (MFPR) is well established as an effective intervention to minimize the fetal and maternal health burden consequential to a multiple gestation [Stone et al, 2007]. Although commonly utilized for high order multiple gestations, justification of MFPR in the setting of a twin gestation is debatable [Evans et al, 2004].…”

Section: Selective Embryo Reductionmentioning

confidence: 99%

Epidemic of plurality and contributions of assisted reproductive technology therein

Kapoor¹,

Pal²

2009

American J of Med Genetics Pt C

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“…16 Transvaginal embryo reduction although carried out in many centres due to their learned technical skill, multifoetal embryo reduction carried out transabdominally has been found to be safer and simpler technique than the transvaginal method. 16 Considering the relatively high incidence of vanishing twins 17 concern is sometimes raised about the outcome of the procedure as we may end up, loosing even the viable pregnancies after the procedure is performed. However, there is very low pregnancy wastage after the heartbeat has been established.…”

Section: Discussionmentioning

confidence: 99%

“…We had used potassium chloride in our study though 0.9% sodium chloride has also been used in few other studies. 17 Care has to be taken while using KCl. If the KCl solution accidentally reaches the amniotic fluid of the remaining embryos, this could result in a total pregnancy loss.…”

Section: Discussionmentioning

confidence: 99%

Embryo reduction: our experience

Talwar¹,

Sharma²,

Kharb³

et al. 2011

Medical Journal Armed Forces India

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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.

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Evolving trends in 2000 cases of multifetal pregnancy reduction: a single-center experience

Cited by 35 publications

References 14 publications

Use of exogenous gonadotropins in anovulatory women: a technical bulletin

Use of exogenous gonadotropins in anovulatory women: a technical bulletin

Epidemic of plurality and contributions of assisted reproductive technology therein

Embryo reduction: our experience

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