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Hum. Reprod. Advance Access first published online on September 14, 2006
This version published online on September 29, 2006
Human Reproduction, 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
Received June 7, 2006
Revised August 11, 2006
Accepted August 16, 2006

Article

Factors determining early pregnancy loss in singleton and multiple implantations

M.J. Lambers 1 *, E. Mager 1, J. Goutbeek 1, J. McDonnell 1, R. Homburg 1, R. Schats 1, P.G.A. Hompes 1, and C.B. Lambalk 1

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

* To whom correspondence should be addressed.
M.J. Lambers, E-mail: mj.lambers{at}vumc.nl


  Abstract

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 11.4% (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.

Keywords: gestational sac/implantation/IVF/pregnancy loss/twin.

This is a new version of this article as errors were found in the data in Table II.


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