Prevention of multiple gestation(MG) after assisted reproductive technology (ART)

Abstract

OBJECTIVE: To develop a decision aid (DA) to help patients decide the optimal number of ET after ART. DESIGN: Prospective cohort. MATERIALS AND METHODS: 1) International Patient Decision Aid Standards for DA: interviews and focus groups of ART providers and patients informed the structure of the DA. Options (#ET) with their benefits (pregnancy) and harms (MG and related risks) are presented. 2) Systematic reviews (SR) give probabilities of maternal and infant risks associated with singleton, twin, and triplet+ MG for 18 outcomes. 3) A novel math model predicts implantation rates for day 3 and day 5 embryos and the probability of singleton, twin or higher based on the # and quality of ET. 4) The DA is tested in 31 patients for: a) change in knowledge about multiple gestation b) patient acceptability. RESULTS: 1) A 2-part DA resulted. Part 1 gives patients age-clinic specific pregnancy/MG rates before ovarian stimulation and helps patients determine values-based risk acceptance. Part 2 gives updated probabilities from the model for singleton,twin and higher order MG based on actual embryo quality on day of ET and #ET. 2) SR showed increased maternal and infant risks specific to ART and MG Eg. Preterm delivery after ART for singletons, twins and triplets+ is 21, 69, and 81% respectively. 3) Model prediction rules had a PPV of 75-85% for day 3 ET. 4) Testing of part 1: Knowledge re: MG was higher post DA (62 vs 77%). All found the DA acceptable, 81% called it “balanced”; 62% found it easy to find the probability of pregnancy but 51% wanted information about embryo quality (part 2) before making the decison. CONCLUSIONS: This DA educates patients about their probability for pregnancy, multiple pregnancy and related risks based on age, clinic and embryo characteristics. Part 1 changes knowledge about MG and is acceptable to patients. Specific information how embryo quality relates to pregnancy and MG is desired by patients before the decision about embryo transfer. Part 2 gives this information. This DA may help prevent MG.