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Fertility and Sterility Oct 2020Multiple birth rates after fertility treatment are still high in many countries. Multiple births are associated with increased rates of preterm birth and low birth... (Review)
Review
Multiple birth rates after fertility treatment are still high in many countries. Multiple births are associated with increased rates of preterm birth and low birth weight babies, in turn increasing the risk of severe morbidity for the children. The multiple birth rates vary in different countries between 2% and 3% and up to 30% in some settings. Elective single-embryo transfer, particularly in combination with frozen-embryo transfer and milder stimulation in ovulation induction/intrauterine insemination, to avoid multifollicular development is an effective strategy to decrease the multiple birth rates while still achieving acceptable live-birth rates. Although this procedure is used successfully in many countries, it ought to be implemented broadly to improve the health of the children. One at a time should be the normal routine.
Topics: Embryo Transfer; Female; Fertilization in Vitro; Humans; Ovulation Induction; Pregnancy; Pregnancy, Multiple; Randomized Controlled Trials as Topic; Reproductive Techniques, Assisted
PubMed: 32826048
DOI: 10.1016/j.fertnstert.2020.07.022 -
BMJ (Clinical Research Ed.) May 1999
Review
Topics: Breech Presentation; Delivery, Obstetric; Dystocia; Female; Humans; Labor Presentation; Pregnancy; Pregnancy, Multiple; Prenatal Care; Prolapse; Umbilical Cord
PubMed: 10221949
DOI: 10.1136/bmj.318.7192.1192 -
Archivos Argentinos de Pediatria Jun 2011
Topics: Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Reproductive Techniques, Assisted
PubMed: 21660381
DOI: 10.1590/S0325-00752011000300001 -
Romanian Journal of Ophthalmology 2021Due to the increasing rate of couples suffering from infertility, recently, the use of assisted reproductive technology (ART) has increased by 5%-10% per year. Some ART... (Review)
Review
Due to the increasing rate of couples suffering from infertility, recently, the use of assisted reproductive technology (ART) has increased by 5%-10% per year. Some ART pregnancies are at risk of obstetric and neonatal complications, but it is unknown whether the procedures used or the etiology of infertility influences this risk. Multiple ART pregnancies are responsible for the increased rate of prematurity and its associated complications. Also, it has been demonstrated that ART pregnancies have a higher risk of congenital anomalies. The rate of ART-associated ocular abnormalities is incompletely known due to a small number of studies conducted regarding this pathology. In this paper, we presented a review of literature on ocular anomalies associated with ART in order to raise awareness of the need to implement ophthalmological screening in children from pregnancies obtained by ART. ART = assisted reproductive techniques, IVF = in vitro fertilization, ICSI = intracytoplasmic sperm injection, LBW = low birth weight, ROP = retinopathy of prematurity.
Topics: Child; Female; Fertilization in Vitro; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Reproductive Techniques, Assisted; Sperm Injections, Intracytoplasmic
PubMed: 35087971
DOI: 10.22336/rjo.2021.65 -
Fertility and Sterility Apr 2011To describe a rare case of a heterotopic pregnancy with a gestational sac in the cervix and one in the uterine cavity, managed successfully with subsequent delivery of a... (Review)
Review
OBJECTIVE
To describe a rare case of a heterotopic pregnancy with a gestational sac in the cervix and one in the uterine cavity, managed successfully with subsequent delivery of a healthy newborn.
DESIGN
Case report and review of the literature.
SETTING
Tertiary university hospital.
PATIENT(S)
A woman with heterotopic twin gestation after stimulation treatment at 9 weeks gestation. Transvaginal ultrasound scan revealed two gestational sacs containing two viable fetuses: one sac inside the uterine cavity and the other sac in the uterine cervix.
INTERVENTION(S)
Selective termination of the cervical pregnancy by curettage under sonographic guidance in combination with cervical cerclage.
MAIN OUTCOME MEASURE(S)
Intrauterine pregnancy preservation; maternal morbidity and mortality.
RESULT(S)
The termination of the cervical pregnancy was performed successfully without intraprocedural or postprocedural complications with preservation of the patient's fertility. The intrauterine pregnancy progressed uneventfully through 39½ weeks with delivery of a healthy newborn.
CONCLUSION(S)
Combined intrauterine and cervical pregnancy is a remote but possible event, particularly after assisted reproductive technology procedures with a high rate of maternal morbidity. Other factors such as concomitant intrauterine pregnancy and the patient's infertility history generally would be secondary concerns. In this case, we were able to terminate the cervical pregnancy selectively, while preserving the intrauterine one, allowing this couple to have a healthy newborn.
Topics: Adult; Cervix Uteri; Female; Health; Humans; Infant, Newborn; Live Birth; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Twins
PubMed: 21122844
DOI: 10.1016/j.fertnstert.2010.10.043 -
Yonsei Medical Journal Apr 2002As a result of the increased use of drugs that enhance fertility, and the advent of in vitro fertilization and embryo transfer over the last 2 decades, the incidence of... (Review)
Review
As a result of the increased use of drugs that enhance fertility, and the advent of in vitro fertilization and embryo transfer over the last 2 decades, the incidence of multifetal pregnancies has increased exponentially. In parallel with this increase methods of care for women carrying multiple fetuses have become more complex and well developed. Importantly, it has become obvious that in the case of such pregnancies the rates of mortality and morbidity of both fetuses and mothers, particularly in cases where four or more fetuses are involved, are extremely high. Improvements in the techniques of assisted fertilization should result in fewer iatrogenic multifetal pregnancies and a commensurate decrease in related risks. Fetal reduction seems to be an acceptable method of improving maternal and fetal outcome in high order multiple pregnancies despite the many unresolved medical and ethical dilemmas.
Topics: Ethics, Medical; Female; Humans; Pregnancy; Pregnancy Reduction, Multifetal; Pregnancy, Multiple
PubMed: 11971220
DOI: 10.3349/ymj.2002.43.2.252 -
Human Reproduction (Oxford, England) Nov 2022
Topics: Humans; Pregnancy; Female; Live Birth; Pregnancy, Multiple; Pandemics
PubMed: 36228657
DOI: 10.1093/humrep/deac232 -
Ultrasound in Obstetrics & Gynecology :... Mar 2006
Topics: Female; Humans; Pregnancy; Pregnancy, Multiple; Reproductive Techniques, Assisted; Twins, Monozygotic
PubMed: 16482610
DOI: 10.1002/uog.2730 -
Fertility and Sterility Jan 2022To determine the proportion of pregnancies resulting in birth that were conceived with the use of clomiphene citrate (CC) and the frequency of multiple pregnancy.
OBJECTIVE
To determine the proportion of pregnancies resulting in birth that were conceived with the use of clomiphene citrate (CC) and the frequency of multiple pregnancy.
DESIGN
Whole-of-population cohort study, constructed through data linkage. Comprehensive Australian Government records of dispensed medications were linked to state Perinatal Registry records for all births of at least 20 weeks' gestation.
SETTING
The state of South Australia.
PATIENT(S)
Women who maintained pregnancy for at least 20 weeks and gave birth between July 2003 and December 2015, a total of 150,713 women with 241,561 pregnancies.
INTERVENTION(S)
Not applicable.
MAIN OUTCOME MEASURE(S)
Ongoing pregnancy occurring in proximity to CC, defined as dispensing from 90 days before to the end of a conception window derived from newborn date of birth and gestational age.
RESULT(S)
Linkage to dispensed prescription records was achieved for 97.9% of women. Women who conceived with CC tended to be older and socioeconomically advantaged and more likely than other women to have a history of miscarriage. Ongoing pregnancies associated with CC comprised 1.6% of the total; 5.7% were multiple births (mostly twins, 94.6%) compared with 1.5% in the remainder (98.5% twins).
CONCLUSION(S)
In South Australia, 1.6% of pregnancies (1 in 60) of at least 20 weeks' gestation were conceived proximal to CC dispensing. Of these, 5.7% were multiple pregnancies. This takes the proportion of women who achieved an ongoing pregnancy with medical assistance from 4.4%, based on reports from assisted reproductive technology clinics, to 6% in total.
Topics: Adult; Australia; Clomiphene; Cohort Studies; Female; Humans; Infant, Newborn; Infertility; Male; Middle Aged; Practice Patterns, Physicians'; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Prevalence; Reproductive Techniques, Assisted; Young Adult
PubMed: 34656304
DOI: 10.1016/j.fertnstert.2021.08.030 -
Fertility and Sterility Dec 2005To collect data on every baby born in one week in the United Kingdom with respect to mode of conception, multiplicity of pregnancy, and outcome.
OBJECTIVE
To collect data on every baby born in one week in the United Kingdom with respect to mode of conception, multiplicity of pregnancy, and outcome.
DESIGN
A questionnaire completed by the midwife birth attendant.
SETTING
All maternity units in the United Kingdom.
PATIENT(S)
All mothers delivering during the week of April 6-12, 2003.
INTERVENTION(S)
Questionnaire survey.
MAIN OUTCOME MEASURE(S)
Mode of conception (both spontaneous and assisted), type of fertility treatment, multiplicity of pregnancy, mode of delivery, gestational age, and fetal outcome.
RESULT(S)
Data were received from 178 maternity units (72.7%) on 6,913 deliveries: 6,812 (98.54%) were singleton, 100 (1.45%) twin, and 1 (0.01%) triplet. In total, 7,015 babies were born. Of all pregnancies, 6,638 (96%) (including the only triplet) were conceived spontaneously and 133 (1.9%) with assistance. The multiple pregnancy rate was significantly greater in assisted (13.5%) than in spontaneous (1.2%) conceptions. Of the multiple pregnancies after fertility treatment, 16.7% resulted from clomifene citrate therapy, 72.2% from IVF or frozen embryo replacements (FET), and 5.6% from superovulation with intrauterine insemination (IUI). The multiple pregnancy rate after IVF/FET (26%) was significantly higher than the one after clomifene citrate therapy (7.3%). In total, 41 babies were born after clomifene citrate therapy, 50 after IVF/ET, and eight after superovulation IUI. The live birth rate was higher for singleton (98.2%) than multiple pregnancies (93.6%).
CONCLUSION(S)
Multiple pregnancy from IVF and related treatments remains a significant problem and contributes a greater burden than ovulation induction therapies.
Topics: Congenital Abnormalities; Data Collection; Delivery, Obstetric; Female; Fertilization; Fertilization in Vitro; Gestational Age; Humans; Incidence; Infant, Newborn; Infertility, Female; Intensive Care, Neonatal; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Stillbirth; Surveys and Questionnaires; United Kingdom
PubMed: 16359972
DOI: 10.1016/j.fertnstert.2005.05.052