Complications of pregnancy after infertility treatment: awareness and prevention

Pregnancy Outcome Among Twins Conceived After Subfertility Treatment Compared With Natural Twins: A Population-Based Study

Pregnancy outcome and characteristics of women who conceive following subfertility treatment remains a subject of great interest. We analyzed these variables among 199 women who delivered a registerable twin birth compared with 1773 women who delivered a naturally conceived twin birth in a population-based obstetric cohort drawn from around Oxford, England. Treatment was restricted to conceptions involving simple ovulation induction only. Treated mothers were of significantly higher social class and older, more likely to deliver girls and to be delivered by cesarean section, and significantly less likely to be smokers at the time of antenatal booking and to have delivered previous pregnancies. Pregnancy outcome was similar between the two groups for most measures, with the exception of birthweight which was lower in treated twins, though not significantly so. Overall the results are reassuring with respect to outcome in twin pregnancies following simple ovulation induction.

First-trimester fetal reduction to a singleton infant or twins: outcome in relation to the final number and karyotyping before reduction by transabdominal chorionic villus sampling

OBJECTIVE

The purpose of this study was to evaluate fetal outcome and maternal complications of multifetal pregnancy reduction to a single fetus or twins. To evaluate safety and efficacy of transabdominal chorionic villus sampling for karyotyping before fetal reduction.

STUDY DESIGN

Four hundred twenty-four consecutive multiple pregnancies were reduced to twins (255 pregnancies) or a single fetus (169 pregnancies) at 8 to 13 weeks of gestation after transabdominal chorionic villus sampling for fetal karyotyping. Fetal and maternal outcome were observed prospectively and compared with control series of twin (147) and singleton (885) pregnancies in which reduction procedures were not performed.

RESULTS

Transabdominal chorionic villus sampling was performed successfully in 100% of the cases. The accuracy of karyotyping was 99.2%. The overall pregnancy loss rate after reduction was 3.3%. No differences were observed between study and control series for severe prematurity, low birth weight, and neonatal deaths. Mean gestational age at delivery (35.2% vs 38.1%) and mean birth weight (2180 g vs 2873 g) were significantly lower; preterm delivery (64% vs 11%), neonatal death (3.4% vs 0.6%), and maternal complications (42.8% vs 9.5%) were significantly higher when the reduction was to twins rather than in reduction to a single fetus. Pregnancy loss rate did not differ between study series. The overall rate of chromosomal abnormalities in the study series was higher (relative risk, 2.0) than in singleton control series.

CONCLUSION

The outcome of multiple pregnancies that were reduced to a single fetus or twins was similar to that of nonreduced pregnancies; fetal and maternal complications were significantly lower in the series of pregnancies that were reduced to a single fetus. The safety and efficacy of transabdominal chorionic villus sampling and the higher pregnancy rate of chromosomal abnormalities in multiple pregnancies imply that fetal karyotyping should be advised before fetal reduction.

Female infertility

This article has provided outcome-based evidence using easily understood graphic representation of cumulative pregnancy rates whenever possible for the methods used to investigate and treat female infertility. A scheme of basic routine investigations in specialist practice is developed and clear guidance provided on the choice of treatment for each couple.