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At least 37 records · Page 2Linked to original sources
PubMed2005

Influence of embryo quality and number of previous cycles on pregnancy and multiple pregnancy rates in women aged 35 to 37 years who received two or three embryos.

Women aged 35-37 years undergoing IVF-ET with fresh embryos at a university infertility center were analyzed to evaluate factors useful in determining whether two or three embryos should be transferred in this age group. Embryo quality and number, but not number of previous failed cycles, were important in determining outcome, and all triplet pregnancies could have been avoided at our program in this age group by limiting the transfer to two good-quality embryos, without reducing pregnancy rates.

Adult↗
PubMed1997

Outcomes of multifetal pregnancy reduction in multiple pregnancies achieved by intracytoplasmic sperm injection using ejaculated, testicular, or epididymal sperm.

OBJECTIVE: To report the pregnancy outcome after transabdominal multifetal pregnancy reduction in multiple pregnancies achieved by intracytoplasmic sperm injection. METHODS: One twin and 13 triplet pregnancies obtained by intracytoplasmic sperm injection underwent pregnancy reduction. Pregnancies were achieved with ejaculated sperm in 8, testicular sperm in 3, and epididymal sperm in 2 of these cases. All triplet pregnancies were reduced to twins at 10-12 weeks' gestation by transabdominal potassium chloride injection. A twin pregnancy with spina bifida affecting 1 fetus was reduced to singleton at 18 weeks of pregnancy. RESULTS: There was no failed procedure and no pregnancy loss within the first 4 weeks after the procedure. A complete miscarriage (7.1%) developed in 1 case at 17 weeks' gestation which was due most probably to the incompetent cervix. In utero fetal death occurred in 1 fetus of another reduced pregnancy. Three of the reduced pregnancies delivered at term, after 37 completed weeks, four premature deliveries occurred between 31 and 35 gestational weeks, and four pregnancies were ongoing beyond 25 weeks' gestation. A total of 16 fetuses, from seven twin and two singleton pregnancies, were delivered without perinatal mortality. CONCLUSIONS: Although the sample size was small, our experience indicates that the reduction of triplets obtained by sophisticated infertility treatments such as intracytoplasmic sperm injection using testicular or epididymal sperm seems to be a safe method and can be effectively used.

Abortion, Spontaneous↗
PubMed1990

Multiple pregnancy.

Most multiple pregnancies are diagnosed, but early diagnosis still presents some problems. Congenital malformation is commoner in multiple pregnancies, usually without concordance, which complicates decisions about pregnancy termination. Because of the higher perinatal mortality rates, women with multiple pregnancies should be offered extra antenatal care, with the specific objectives of early diagnosis and timely treatment of pre-eclampsia, preterm labour and growth retardation. If growth retardation affects only one fetus, intervention must be carefully judged. Measures such as bedrest, fetal monitoring and elective operative delivery are reviewed, and no evidence of benefit is found from their routine use. However, such interventions are valuable in selected cases.

Delivery, Obstetric↗
PubMed2000

[Peculiarities of multiple pregnancy: embryology].

Multiple pregnancies are not physiologic in humans and the understanding of the pathogenesis of this phenomenon is not fully established. Embriology of multiple pregnancy has been extensively investigated and this paper presents the phases of embrional development of monozygotic and dizygotic twins.

Embryonic and Fetal Development↗
PubMed2000

[Peculiarities of multiple pregnancy: complications].

Multiple pregnancies are considered high risk. This qualification is associated with the multitude of conditions which are known to complicated these pregnancies. Early diagnosis of these complications is the fundamental element of clinical managements. In numerous cases therapeutic protocols are widely known and in many others intensive monitoring and appropriate management may save the fetus from early and late complications. This paper will discuss the most common prenatal and perinatal complications associated with multiple pregnancies as well as the most widely accepted therapeutic protocols.

Abnormalities, Multiple↗
PubMed1997

The optimal number of embryos to be transferred in shared oocyte donation: walking the thin line between low pregnancy rates and multiple pregnancies.

There has been growing concern about the number of multiple gestations resulting from assisted reproductive technologies. For in-vitro fertilization (IVF), there are guidelines concerning the number of embryos to be transferred. In oocyte donation, however, there is a paucity of studies addressing this issue and common practice is extrapolated from standard IVF procedures. This may not be correct since endometrial receptivity has been shown to be altered in oocyte donation. Thus the purpose of this study was to assess the optimal number of embryos to be transferred in oocyte donation. The study population included 254 patients with ovarian failure who underwent a total of 601 embryo transfers in a single shared oocyte donation programme. Pregnancy rates (PRs), multiple pregnancies, triplet pregnancy rates, and implantation rates were evaluated according to the number of embryos transferred. A significant linear increase in PRs was noted with the increasing number of embryos transferred up to five (11.1% for one embryo, 36.7% for five embryos). Multiple pregnancies increased significantly from 15.8% for two embryos transferred, to 44.4% for five embryos. The rate of triplet pregnancies also increased from 2.7% for three embryos transferred, to 8.3% for five embryos. Optimization of the number of embryos to be transferred is discussed.

Adult↗
PubMed2002

Prenatal diagnosis for multiple pregnancies.

In multiple pregnancies, first trimester ultrasound is crucial to diagnose chorionicity, to detect major structural defects, and to screen for chromosomal abnormalities based on nuchal translucency measurement. The efficacy of nuchal translucency measurement screening in twins might be improved when combined with first trimester maternal serum screening. In twins as in singletons, the risk of fetal loss attendant to chorionic villi sampling and to amniocentesis are similar. When an invasive procedure is indicated in twins, chorionic villi sampling has, over amniocentesis, the advantage of allowing selective termination to be performed in the first trimester, when the procedure related risk of miscarriage is minimal. It has the disadvantage of leading to ambiguous results in up to 2% of cases. While chorionic villi sampling is the choice technique in pregnancies at very high risk, amniocentesis is still indicated in cases at more moderate risk. In monochorionic pregnancies, selective termination can now be performed using a variety of techniques including bipolar or monopolar cord coagulation, and, in acardiac twins, alcohol ablation. However, selective termination remains more hazardous in monochorionic than in dichorionic pregnancies. The outcome of the twin-to-twin transfusion syndrome has been substantially improved by laser photocoagulation of placental shunts and by amniodrainage, but randomized trials are needed to establish the optimal therapeutic strategy, and further pathophysiologic research might result in new treatments.

Amniocentesis↗
PubMed2001

Transfer of two embryos instead of three will not compromise pregnancy rate but will reduce multiple pregnancy rate in an assisted reproduction unit.

OBJECTIVE: To compare the pregnancy rates and multiple pregnancy rates of cycles initiated in 1998 and in 1999, during which 3 and 2 embryos were advised to be replaced, respectively. STUDY DESIGN: A retrospective study RESULTS: There were no differences between 1998 and 1999 in the pregnancy rate per cycle started or per transfer, implantation rate and the multiple pregnancy rates, despite a significantly lower number of embryos replaced in 1999. A significantly higher implantation rate was found in cycles with frozen embryos than those without. Using logistic regression analysis, the chance of pregnancy was significantly improved only by the presence of frozen embryos in the fresh cycles with an odds ratio of 2.0 (95% confidence interval: 1.3-3.0) whereas the chance of multiple pregnancy was significantly increased by replacing 3 embryos instead of 2 (odds ratio: 2.1, 95% confidence interval: 1.1-4.2). CONCLUSION: Patients should be advised to have 2 embryos replaced without jeopardizing the pregnancy rates in the fresh cycles. The risk of multiple pregnancy is significantly increased when 3 embryos are transferred instead of 2.

Adult↗
PubMed1990

[Pregnancy outcome following cerclage. 2. Multiple pregnancy].

In a retrospective study pregnancy and labour after cerclage had been studied in comparison to 160 patients with singleton pregnancies and a matched pair control group of multiple pregnancies without operative cervix closure. Cervical incompetence in multiple pregnancy observed more frequently than in singleton ones is not correlated to obstetric history, but has a bad prognosis because of necessity of tocolysis during pregnancy, marked shortening of duration of pregnancy, lowering of length and weight of newborns. An increase in frequency of amniotic infections had to be calculated following cerclage in multiple pregnancies, too. Our results especially in multiple pregnancies are not so optimistic. This statement is valid also for the indication to its prophylactic use.

Adult↗
PubMed1992

Relationship of follicle number and other factors to fecundability and multiple pregnancy in clomiphene citrate-induced intrauterine insemination cycles.

OBJECTIVE: To determine characteristics associated with pregnancy and multiple gestation after clomiphene citrate (CC)-intrauterine insemination (IUI). DESIGN: Prospective study of all patients undergoing CC-IUI between January 1, 1983 and December 31, 1989. SETTING: Private fertility clinic. PATIENTS: Eight hundred forty-nine patients undergoing 1,974 cycles of CC-IUI. MAIN OUTCOME MEASURES: Relationship between number and size of preovulatory follicles, age, additional infertility diagnosis, medication, and initial semen quality to fecundity, birth, and multiple gestation. RESULTS: Uncorrected, per cycle fecundity was 7.2%. The number of follicles greater than or equal to 12 mm (r = 0.055, P less than 0.05) was and the number greater than or equal to 15, 18, and 21 mm was not correlated with fecundity. Endometriosis with (P = 0.013) or without (P less than 0.0005) tubal adhesions and tubal adhesions alone (P = 0.005), decreased fecundability by 50%. Initial semen quality did not affect fecundity, unless semen concentration was less than 5 x 10(6)/mL or motility was less than 20%. Multiple pregnancy was not associated with the dose of CC, use of human chorionic gonadotropin, or number of follicles. CONCLUSIONS: Multiple pregnancy was unrelated to follicle numbers or to CC dose. The highest birth rates after CC-IUI occurred when initial sperm concentration was greater than or equal to 5 x 10(6)/mL, motility was greater than or equal to 20%, and no endometriosis or adhesions were present.

Clomiphene↗
PubMed2005

New Belgian legislation regarding the limitation of transferable embryos in in vitro fertilization cycles does not significantly influence the pregnancy rate but reduces the multiple pregnancy rate in a threefold way in the Leuven University Fertility Center.

After the introduction of new Belgian legislation limiting the number of transferable embryos to prevent multiple pregnancies after assisted reproductive technology, the implantation rate per embryo remained stable at 26% and the clinical pregnancy rate per embryo transfer did not change significantly (37.5% before and 32.5% after legislation), whereas the multiple pregnancy rate per clinical pregnancy decreased threefold from 25.9% to 8.0%) in the Leuven University Fertility Center.

Academic Medical Centers↗
PubMed2004

Evidence-based care of women with a multiple pregnancy.

Women with a multiple pregnancy face greater risks for themselves and their infants than women pregnant with one child. Pre-pregnancy care should focus on avoiding multiple pregnancy. Early prenatal care centres on determining chorionicity and screening for fetal anomalies, with later care focusing on the presentation, prediction and management of preterm birth, and intrauterine growth restriction. The optimal timing and mode of birth are the focus of current multicentre, randomised, controlled trials. However, the data from such trials on care for women with a multiple pregnancy are limited. Many areas of care require better-quality information, including when using assisted reproductive techniques, the optimal number of embryos to be transferred, care after the diagnosis of chorionicity, and the benefits of specialised multiple pregnancy clinics. Better-quality information is required to inform clinical practice for women with complications of multiple pregnancy, including monoamniotic twin pregnancy, treatment of twin-to-twin transfusion syndrome, and care following single intrauterine fetal death.

Diseases in Twins↗
PubMed2000

[The significance breast feeding on the course of the adaptation period in neonates from multiple pregnancies].

Neonates from multiple pregnancies were evaluated taking into account their condition in the 1st and 5th minutes after birth, their birth weight, time which they spent in the neonatal department and occurrence of complications during the adaptation period, such as respiratory insufficiency, intrauterine infection and hyperbilirubinaemia. On the basis of our research, we think that multiple pregnancy requires particular diagnostics and individualisation of prenatal care. We believe also that neonates from such pregnancies are particularly exposed to development of a severe form of diverse complications. In our investigations, we observed a beneficial influence of breast-feeding--from the first hours of life--on the course of adaptation of neonates. However, we think that confirmation of these findings requires more detailed investigations.

Adaptation, Physiological↗