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Human Reproduction, Vol. 15, No. 10, 2228-2233, October 2000
© 2000 European Society of Human Reproduction and Embryology

Embryo reduction of multifetal pregnancies following assisted reproduction treatment: a modification of the transvaginal ultrasound-guided technique

G. Ibérico1, J. Navarro1, L. Blasco1,3, C. Simón1,2, A. Pellicer1,2 and J. Remohí1,2,4

1 Instituto Valenciano de Infertilidad (IVI), 2 Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Spain and 3 Hospital of the University of Pennsylvania, Department of Obstetrics and Gynecology, Pennsylvania, USA

First-trimester transvaginal embryo reduction is an effective alternative for the management of multifetal pregnancy in assisted reproduction. We have modified the transvaginal technique by performing an intracardiac embryo puncture until asystolia is verified, without the injection of any substances. Any aspiration of embryo tissues or amniotic fluid was avoided. A total of 149 multifetal pregnancies was reduced to twins (n = 134) or singletons (n = 15) at early gestational age (7.8 ± 0.8 weeks). Eleven cases (7.3%) of miscarriage, two cases (1.3%) of chorioamnionitis, and 17 cases (11.4%) of transient spotting were recorded as postoperative complications. Vanishing of one embryo occurred in four cases (3.0%) of those reduced to twins. The baby take-home rate was 89.5% for twins and 80.0% for singletons. Pregnancy outcome was analysed and compared with a control group of women with non-reduced multiple pregnancies. The birth weight of singleton pregnancies after reduction was lower (2929 ± 160 versus 3291 ± 422 g; P < 0.02). These studies show that early transvaginal intracardiac embryo puncture is an effective and safe technique.

Key words: embryo reduction/multifetal pregnancy/transvaginal ultrasound-guided technique

4 To whom correspondence should be addressed at: Instituto Valenciano de Infertilidad, Guardia Civil 23, 46020-Valencia, Spain. E-mail: jmnavarrop{at}yahoo.com


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