Spontaneous reduction of multiple pregnancy: Incidence and effect on outcome

Dickey, Richard P.; Taylor, Steven N.; Lu, Peter Y.; Sartor, Belinda M.; Storment, John; Rye, Phillip H.; Pelletier, William D.; Zender, James L.; Matulich, Ellen M.

doi:10.1067/mob.2002.118915

Cited by 263 publications

(183 citation statements)

References 18 publications

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“…This view is supported by the assumption that implantation is less likely with low-quality embryos (9), and would not make it to the stage of live embryos. This might explain the differences between our observation (which counted embryos with positive heartbeats) and studies that counted gestational sacs (1).…”

Section: Discussioncontrasting

confidence: 89%

“…Early loss of the entire pregnancy, irrespective of plurality, is considered as miscarriage, whereas partial loss in a multiple pregnancy is usually considered in the context of spontaneous reduction (1) or the vanishing twin syndrome (2). Most texts on multiple gestations would submit to an increased embryonic loss among twin gestations compared to singletons.…”

Section: Introductionmentioning

confidence: 99%

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Lower embryonic loss rates among twin gestations following assisted reproduction

Sala¹,

Nucera²,

Gallinelli³

et al. 2005

J Assist Reprod Genet

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Purpose : To determine whether maternal age and number of transferred embryos influence early pregnancy losses in twin pregnancies compared to singletons following IVF/ICSI. Methods : We compared the pregnancy loss rates in singleton (n = 549) and twin (n = 252) gestations, stratified by maternal age (≤35 and >35 years) and the number of transferred embryos (1-3 and 4-9). Results : Loss rates of singleton pregnancies were significantly higher than that in twins (OR 3.0, 95% CI 1.9, 4.9), especially among singletons conceived after transfer of 4-9 embryos (OR 5.0, 95% CI 2.2, 11.9). Younger mothers of twins had lower loss rates (OR 0.3, 95% CI 0.1, 0.9). Conclusion : Twins have a significantly reduced spontaneous miscarriage rate compared with singletons following IVF/ICSI. Higher implantation rates per cycle (i.e., development of twins rather than one live embryo) may represent a better capacity of the uterus for early embryonic development.

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Section: Discussioncontrasting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Lower embryonic loss rates among twin gestations following assisted reproduction

Sala¹,

Nucera²,

Gallinelli³

et al. 2005

J Assist Reprod Genet

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“…Moreover, two previous studies on 213 and 1597 clinical assisted reproductive technique pregnancies demonstrated that 12-30% of twin pregnancies, recognized by transvaginal sonography in gestational week 8, end up as a singleton birth, 60-83% as twin deliveries and 5-10% as spontaneous abortions of both fetuses (Landy and Keith, 1998;Tummers et al, 2003). The current knowledge on the incidence of spontaneous reductions (vanishing twins) in IVF pregnancies is scarce, and only a few studies have shown that the higher the number of gestational sacs the higher obstetric risks, irrespective of the final birth number (Dickey et al, 2002;Schieve et al, 2002;Lancaster, 2004). However, a recent study with 6377 IVF infants showed that elevated risk ratios of five perinatal outcomes of IVF singletons remained elevated although diminished, when restricted to infants with only one fetal heart in early pregnancy (Schieve et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Consequences of Vanishing Twins in IVF/ICSI Pregnancies

Pinborg

Lidegaard

Freiesleben

et al. 2006

Obstetrical & Gynecological Survey

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BACKGROUND: Spontaneous reductions are a possible cause of the increased morbidity in IVF singletons. The aim of this study was to assess incidence rates of spontaneous reductions in IVF/ICSI twin pregnancies and to compare short-and long-term morbidity in survivors of a vanishing co-twin with singletons and born twins. METHODS: We identified 642 survivors of a vanishing co-twin, 5237 singletons from single gestations and 3678 twins from twin gestations. All children originated from pregnancies detected by transvaginal sonography in gestational week 8. By crosslinkage with the national registries the main endpoints were prematurity, birth weight, neurological sequelae and mortality. RESULTS: Of all IVF singletons born, 10.4% originated from a twin gestation in early pregnancy. Multiple logistic regression analyses adjusted for maternal age, parity and ICSI treatment showed for birth weight <2500 g an odds ratio (OR) of 1.7 [95% confidence interval (CI) 1.2-2.2] and for birth weight <1500 g OR 2.1 (95% CI 1.3-3.6) in singleton survivors of a vanishing twin versus singletons from single gestations; corresponding figures were seen for preterm birth. This increased risk was almost entirely due to reductions that occurred at >8 weeks gestation. We found no excess risk of neurological sequelae in survivors of a vanishing co-twin versus the singleton cohort; however, OR of cerebral palsy was 1.9 (95% CI 0.7-5.2). Furthermore, we observed a correlation between onset of spontaneous reduction, i.e. the later in pregnancy the higher the risk of neurological sequelae (r = -0.09; P = 0.02). Adjusted OR of child death within the follow-up period was 3.6 (95% CI 1.7-7.6) in the survivor versus the singleton cohort. CONCLUSIONS: One in 10 IVF singletons originates from a twin gestation. Spontaneous reductions that occur at >8 weeks gestation are one of the causes for the higher risk of adverse obstetric outcome in IVF singletons.

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“…Singleton pregnancies that began as multiple gestations are known to be at increased risk of pre-term birth [14,15]. There were significantly more vanishing twins among day 5/6 ETs than day 3 ETs (14.8 vs 7.4 %, p<0.0001).…”

Section: Discussionmentioning

confidence: 99%

A comparison of pregnancy outcomes between day 3 and day 5/6 embryo transfers: does day of embryo transfer really make a difference?

Maxwell

Melzer-Ross²,

McCulloh

et al. 2015

J Assist Reprod Genet

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Purpose To determine if day of embryo transfer (ET) affects gestational age (GA) and/or birth weight (BW) at a single university fertility center that primarily performs day 5/6 ET. Methods Retrospective cohort study of 2392 singleton live births resulting from IVF/ICSI at a single large university fertility center from 2003 to 2012. Patients were stratified by day 3 or day 5/6 ET. Outcome variables included patient age, gravidity, prior miscarriages, prior assisted reproduction technology cycles, number of embryos transferred, number of single ET, infertility diagnosis, neonatal sex, GA at birth, and BW. Subanalyses were performed on subgroups of preterm infants. A comparison was made between the study data and the Society of Assisted Reproductive Technologies (SART) published data. Results There was no difference in GA at birth (39±2.1 weeks for day 3 ET, 39±1.9 weeks for day 5/6 ET) or BW between ET groups (3308±568 g for day 3 ET, 3268±543 g for day 5/6 ET). There was also no difference in the number of preterm deliveries (8.5 % for day 3 ET vs. 10.8 % for day 5/6 ET). The day 5/6 ET study data had significantly fewer pre-term deliveries than the SART day 5/6 ET data. Conclusion In contrast to published SART data, GA and BW were not influenced by day of ET. Data may be more uniform at a single institution. Day 5/6 ET continues to offer improved pregnancy rates without compromising birth outcomes.

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Spontaneous reduction of multiple pregnancy: Incidence and effect on outcome

Cited by 263 publications

References 18 publications

Lower embryonic loss rates among twin gestations following assisted reproduction

Lower embryonic loss rates among twin gestations following assisted reproduction

Consequences of Vanishing Twins in IVF/ICSI Pregnancies

A comparison of pregnancy outcomes between day 3 and day 5/6 embryo transfers: does day of embryo transfer really make a difference?

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