Are in vitro fertilization pregnancies with early spontaneous reduction high risk?
ABSTRACT 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.
Gynécologie Obstétrique & Fertilité 05/2007; 35(5):474-479. DOI:10.1016/j.gyobfe.2007.02.009 · 0.58 Impact Factor
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ABSTRACT: OBJECTIVE: To estimate the cumulative probability of liveborn multiples after IVF to improve patient counseling regarding this significant morbidity. DESIGN: Retrospective cohort study. SETTING: Large academic-affiliated infertility practice. PATIENT(S): A total of 10,169 women were followed from their first fresh, nondonor IVF cycle through up to six fresh and frozen IVF cycles from 2000-2010. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Delivery of a liveborn infant(s). RESULT(S): After three IVF cycles the cumulative live birth rate (CLBR) was 53.2%. The singleton, twin, and triplet CLBRs were 38.0%, 14.5%, and 0.7%. After six IVF cycles the CLBR was 73.8%, with 52.8%, 19.8%, 1.3% for singletons, twins, and triplets. Of the 5,433 live births, 71.4% were singletons, 27.1% were twins, and 1.5% were triplets. Women more than 39 years had the lowest incidence of liveborn multiples with CLBRs of 5.2% after three cycles and 9.5% after six cycles. The twin CLBR doubled from cycles 1 through 3 with the rate of increase slowing from cycles 3 through 6. Although very low in absolute terms, the triplet CLBR also doubled from cycles 1 through 3 and doubled again from cycles 3 through 6. Of the 1,970 pregnancies that began as multifetal on ultrasound, 77.4% resulted in liveborn multiples. CONCLUSION(S): Providers should be aware of the cumulative probability of liveborn multiples to effectively counsel patients on this important issue. With nearly three-quarters of all women having live birth after up to six IVF cycles, it is encouraging to report a low incidence of liveborn multiples.Fertility and sterility 11/2012; 99(2). DOI:10.1016/j.fertnstert.2012.10.018 · 4.30 Impact Factor
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ABSTRACT: To evaluate whether vanishing twin syndrome (VTS) is associated with adverse perinatal outcome. A retrospective cohort study investigating the impact of VTS on perinatal outcome was conducted. Parturients were classified into three groups: those pregnancies that started with double fetal sacs and spontaneously reduced into one (VTS), those with dichorionic twins, and those with singleton pregnancies. Statistical analysis included multiple logistic regression models to control for possible confounders. Tertiary university medical center. The study involved 252,994 singleton deliveries between the years 1988 and 2012. None. The impact of VTS on perinatal outcome. During the study period, 278 pregnancies with VTS were compared with 1,801 pregnancies of dichorionic twins and 252,994 pregnancies of singletons. A significant linear association was documented among the three groups and various adverse outcomes, including gestational diabetes mellitus (GDM), intrauterine growth restriction (IUGR), very low birth weight (VLBW), and perinatal mortality. The higher risk was noted in the VTS group, and the lowest in singletons. Using multivariable logistic regression models, while controlling for confounders such as fertility treatment and maternal age, VTS (as compared with singletons) was found to be an independent risk factor for several adverse perinatal outcomes including GDM, IUGR, VLBW, low Apgar scores, and perinatal mortality (adjusted odds ratios with their respective 95% confidence intervals, 1.4 [1.01-2.0], 2.7 [1.7-4.3], 6.9 [4.7-10.2], 1.9 [1.1-3.3], 2.4 [1.2-4.5]). Pregnancies with VTS are associated with an adverse perinatal outcome, even after controlling for confounders such as fertility treatment and maternal age. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.Fertility and Sterility 03/2015; DOI:10.1016/j.fertnstert.2015.02.009 · 4.30 Impact Factor