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Twins After Selective Fetal Reduction Differ
Title:Preterm delivery and growth restriction in multifetal pregnancies reduced to twins
Author:N.J. Sebire et al.
Address:London,U.K.
Source:Human Reproduction ;12:173-175,1997 (January)
Summary:127 multifetal pregnancies undergoing selective reduction (abortion) to twins were compared to 354 chromosomally normal non-reduced dichorionic (fraternal) pregnancies. Fetal loss before 24 weeks and the interval between embryo reduction and delivery were significantly associated with the gestation at reduction. Miscarriage rate was higher in the reduced twins (12.6% compared with 2.5%). Median gestation at delivery was lower for the reduced twins (36 compared to 37 weeks) and median birth weight deficit was greater with the reduced twins (-.0.94 to -0.65).
Comment:Multifetal pregnancies (greater than twins), is perhaps the single worse complication of the IVF procedure. The drive for the IVF center toward the highest success rates possible and the honest desire to achieve a pregnancy for the patients is a strong incentive to replace multiple embryos. The financial, emotional and medical costs of multi-fetal pregnancies are extremely high. Fetal reduction appears both relatively safe and effective means to manage pregnancies greater than triplets. The procedure is successful in over 80% of patients. Several other studies have suggested lower fetal weights. This is discordant with the above study. The above results are, in many ways, encouraging when considering the alternatives of to quadruplet , or greater, births. More and larger studies are needed for a comprehensive evaluation of the short and long term effects of this procedure. Outside the United States the number of embryos transferred is limited to 2 or 3 by national statute. Hopefully, as the IVF technology improves, everyone will be contented with transfer fewer of embryos.

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