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Hum. Reprod. Advance Access originally published online on September 14, 2006
Human Reproduction 2007 22(1):275-279; doi:10.1093/humrep/del367
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Factors determining early pregnancy loss in singleton and multiple implantations

M.J. Lambers1, E. Mager, J. Goutbeek, J. McDonnell, R. Homburg, R. Schats, P.G.A. Hompes and C.B. Lambalk

Department of Obstetrics, Gynecology and Reproductive Medicine, Vrije University medical center (VUmc), Amsterdam, The Netherlands

1 To whom correspondence should be addressed at: Department of Obstetrics, Gynecology and Reproductive Medicine, Vrije University medical center (VUmc), PO Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: mj.lambers{at}vumc.nl

BACKGROUND: The incidence of first trimester pregnancy loss is much lower in IVF twin pregnancies than in IVF singleton pregnancies. The objective of this study was to determine which embryonic and maternal factors contribute to this finding. METHODS: Retrospective data analysis of the outcome of 1593 pregnancies after day 3 double-embryo transfer (DET) after IVF or ICSI treatment. RESULTS: Of 1148 single implantations at 6 weeks, 936 (81.5%) were ongoing pregnancies. Of 445 multiple implantations at 6 weeks, 354 (79.6%) were ongoing multiple pregnancies, 80 (17.9%) were ongoing singleton pregnancies and 11 (2.5%) ended in a spontaneous abortion. Total pregnancy loss was 18.5 and 2.5% (P < 0.001) in singleton and twin gestations, respectively. Loss per gestational sac was 18.5 and 11.46% (P < 0.001), respectively. Determinants contributing to the continuation of gestation beyond 6 weeks were young maternal age, possibility to cryopreserve embryos and short GnRH agonist flare-up stimulation protocol. Whereas factors promoting multiple implantation at 6 weeks of gestation were young maternal age, high cumulative embryo score (CES), male infertility, long stimulation protocol and thick endometrium. CONCLUSIONS: Although multiple implantation at 6 weeks is predominantly determined by (morphological) embryo quality, the continuation of pregnancy beyond 6 weeks becomes more dependent on the combination of genetic and developmental potential of the embryo(s) and an optimal uterine milieu.

Key words: gestational sac/implantation/IVF/pregnancy loss/twin


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