The objective of the study was to determine whether spontaneous reduction in in vitro fertilization pregnancies results in outcomes comparable with in vitro fertilization singleton pregnancies or ongoing twin pregnancies.
Women with in vitro fertilization pregnancies from 2003 to 2005 who had first-trimester ultrasound and delivered in our hospital were identified. Those with documented reduction from dichorionic twins to a single viable fetus at 14 weeks or less were categorized as spontaneous reduction pregnancies and were compared with dichorionic twin and singleton pregnancies without reduction.
One hundred sixty-eight singleton, 55 spontaneous reduction, and 86 twin pregnancies were included. Gestational age at delivery was similar in the singleton and spontaneous reduction groups; twins delivered significantly earlier. Spontaneous reduction was associated with lower birth weight than other singleton pregnancies (median 3062 g versus 3425 g; P = .005). The rate of pre-eclampsia was higher in pregnancies with spontaneous reduction, compared with other singleton pregnancies 9.3% versus 2.4%; P = .04).
Spontaneous reduction of a twin to a singleton pregnancy is associated with prolonged gestation and higher birth weight for the remaining fetus.
"A growing body of evidence suggests that ART treatment per se may contribute to this phenomena either through the effect of ovarian stimulation or the technique itself (Wang et al., 2002; Kapiteijn et al., 2006). A number of studies have found that the spontaneous reduction of at least 10% of ART twin pregnancies to viable singleton pregnancies increases the risk of surviving twins having poorer outcomes than true singleton infants (Dickey et al., 2002; Pinborg et al., 2005; Chasen et al., 2006). This finding adds to the impetus to transfer a single embryo during ART procedures. "
[Show abstract][Hide abstract] ABSTRACT: Currently, about one-third of infants born after assisted reproductive technology (ART) worldwide are twins or triplets. This study compared the inpatient birth-admission costs of singleton and multiple gestation ART deliveries to non-ART deliveries.
A cohort of 5005 mothers and 5886 infants conceived following ART treatment were compared to 245 249 mothers and 248 539 infants in the general population. Birth-admission costs were calculated using Australian Refined Diagnosis Related Groups and weighted national average costs (2003-2004 euro).
ART infants were 4.4 times more likely to be low birthweight (LBW) compared with non-ART infants, translating into 89% higher birth-admission costs (euro2,832 and euro1,502, respectively). ART singletons were also more likely to be LBW compared with non-ART singletons, translating into 31% higher birth-admission costs (euro1,849 and euro1,415, respectively). After combining infant and maternal admission costs, the average cost of an ART singleton delivery was euro4,818 compared with euro13 890 for ART twins and euro54 294 for ART higher order multiples. Findings were not sensitive to changes in casemix.
The poorer neonatal outcomes of ART singletons compared with non-ART singletons are significant enough to impact healthcare resource consumption. The high costs associated with ART multiple births add to the overwhelming clinical and economic evidence in support of single embryo transfer.
Human Reproduction 01/2008; 22(12):3108-15. DOI:10.1093/humrep/dem311 · 4.57 Impact Factor
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