Incidence Of High-order Multiple Pregnancies Research Articles

Fewer medications for in vitro fertilization can be better: thinking outside the box

Minimal stimulation or mild stimulation protocols for in vitro fertilization offer many advantages for all patients, but especially for low and high responders. In the current practice of reducing the number of embryos transferred to a maximum of two for a significant number of patients, using aggressive and high-dose gonadotropins to obtain a large, and sometimes excessive, number of oocytes should be questioned.

Use of a prediction model for high-order multiple implantation after ovarian stimulation with gonadotropins

To determine prospectively the effectiveness in clinical practice of a prediction model for high-order multiple pregnancies (HOMP) (triplets or more). Prospective study. University teaching hospital. Eight hundred forty-nine consecutive infertile patients undergoing a total of 1,542 treatment cycles. Gonadotropin ovarian stimulation or induction of ovulation without IVF MAIN OUTCOME MEASURE(S): Observed and predicted overall pregnancy rates and the incidence of HOMP. The use of the prediction model (implying cancellation of all cycles at high risk for HOMP) would result in an 8% (95% confidence interval, 6.8%-9.2%) reduction of overall pregnancy rate but also in a 285% (95% CI, 279%-291%) reduction of HOMP. By using our prediction model, it was possible to maintain a low risk of HOMP with a good pregnancy rate in patients receiving gonadotropin ovarian stimulation or induction of ovulation without IVF.

Expression of sHLA-G in supernatants of individually cultured 46-h embryos: a potentially valuable indicator of ‘embryo competency’ and IVF outcome

A retrospective cohort study was conducted on 201 women aged 28–44 years, each of whom underwent one cycle of IVF–embryo transfer with fresh, intracytoplasmic sperm injection (ICSI)-derived 7- to 10-cell embryos, transferred 72 h after oocyte retrieval. Samples of media surrounding separately cultured embryos were collected 46 h post-ICSI and stored for subsequent specific enzyme-linked immunosorbent assay. A total of 594 embryos (from own or donor oocytes) were transferred to 201 women. Group A comprised 159 recipients under 39 years and group B compromised 42 recipients aged 39–44 years. Groups A-1 and B-1 recipients had at least one embryo that tested above the geometric mean for soluble human leukocyte antigen-G (sHLA-G) (‘positive expression’) transferred. In groups A-2 and B-2, all embryos transferred expressed sHLA-G below the geometric mean (‘negative expression’). In group A-1, 72/101 women (71%) achieved ultrasound confirmed (clinical), viable (cardiac activity observed) pregnancies. The implantation rate per embryo (IR) was 38%. In group A-2, 13/58 (22%) achieved viable clinical pregnancies. The IR was 9%. In group B-1, the viable clinical pregnancy rate was 52% (15/29) and the IR was 25% compared with a viable clinical pregnancy rate of 15% (2/13) and an IR of 5% in group B-2. The results of this study suggest that by selecting specific embryos for transfer based on their individual sHLA-G expression, pregnancy and implantation rates can be maximized while the number of embryos transferred can be reduced, thereby minimizing the incidence of high-order multiple pregnancies.

A year of inaction on high-order multiple pregnancies due to ovulation induction

In the January 2001 issue of Fertility & Sterility, Howard Jones Jr. and John Schnorr reprimanded a U.S. fertility organization for not developing and enforcing guidelines to reduce the incidence of high-order multiple pregnancies (birth of three or more babies) (1). They cited a U.S. Department of Health and Human Services report stating that infertility treatment accounted for more than 225,000 excess multiple births between 1980 and 1997 (2). Ovulation induction exclusive of IVF was responsible for 38% of high-order multiple pregnancies.

Blastocyst transfer: A useful tool for reduction of high-order multiple gestations in a human assisted reproduction program

Objective: We evaluated the efficacy of blastocyst transfer in decreasing the incidence of high-order multiple gestations after in vitro fertilization. Study Design: We conducted a retrospective analysis of 218 patients who were undergoing in vitro fertilization and by our criteria of three 8-cell embryos on day 3 could receive either a day 3 transfer of cleaved embryos or a day 5 transfer of blastocysts. Ongoing pregnancy rates, implantation rates (determined by the total number of visualized gestational sacs), and multiple pregnancy rates were compared between the 2 groups. Results: Respective day 3 and day 5 ongoing pregnancy rates (61% and 51%) and implantation rates (35% and 33%) were not significantly different. There were 9 triplet or higher gestations in the day 3 group and 0 in the day 5 group. Conclusion: Blastocyst transfer can be used to reduce the number of embryos transferred and the resultant incidence of high-order multiple pregnancies while maintaining high pregnancy rates. (Am J Obstet Gynecol 2000;183:377-82.)

Can High-Order Multiple Pregnancy Rates Be Reduced in Infertility Treatment?

Dramatic successes in infertility therapy have unfortunately yielded increased high-order multiple pregnancies. To determine whether the incidence of high-order multiple pregnancies could be reduced without decreasing pregnancy rates, these clinicians analyzed data from 3347 consecutive treatment cycles in 1494 infertile women treated with gonadotropin to …