Abstract
The problem of multiple pregnancies hangs like a millstone around the neck of ovulation induction and ovarian stimulation for IUI and for IVF/embryo transfer. Multiple pregnancies carry an increased risk of premature delivery (×5), perinatal morbidity and mortality and psychological (and financial) implications for the parents. In ovulation induction the predisposing factor is multiple follicular development as it is for gonadotrophin stimulation before IUI whereas in IVF/embryo transfer, it is purely a reflection of the number of embryos transferred. The use of low-dose gonadotrophin protocols minimizes the risk of multiple pregnancies in ovulation induction and stimulation for IUI whereas in IVF/embryo transfer, the high multiple pregnancy rate can be considerably reduced by employing a selective single embryo transfer (eSET) policy without seriously affecting pregnancy rates in suitable candidates especially when frozen/thawed embryos are utilized in subsequent cycles.
Elective single embryo transfer will hopefully be more widely adopted as methods for embryo selection improve as it is the obvious solution for the reduction of the present unacceptable multiple pregnancy rates.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Hamilton-Fairley D, Franks S. Common problems in induction of ovulation. Baillieres Clin Obstet Gynaecol. 1990;4:609–25.
Khalil MR, Rasmussen PE, Erb K, Laursen SB, Rex S, Westergaard LG. Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles. Acta Obstet Gynecol Scand. 2001;80:74–81.
Goverde AJ, McDonnell J, Vermeiden JW, Schats R, Rutten FH, Schoemaker J. Intrauterine insemination or in-vitro fertilization in idiopathic subfertility and male subfertilit: a randomized trial and cost effectiveness analysis. Lancet. 2002;355:13–8.
Ferraretti AP, Goossens V, Kupka M, et al. Assisted reproductive technology in Europe, 2009. Results generated from European registers by ESHRE. Hum Reprod. 2013;28:2318–31.
Nygren KG, Andersen AN. Assisted reproductive technology in Europe, 1999. Results generated from European registers by ESHRE. Hum Reprod. 2002;17:3260–74.
Assisted reproductive technology surveillance – United States, 2010. MMWR Surveill Summ. 2013;62:1–24.
Polson DW, Mason HD, Saldahna MBY, Franks S. Ovulation of a single dominant follicle during treatment with low-dose pulsatile FSH in women with PCOS. Clin Endocrinol (Oxf). 1987;26:205–12.
Homburg R, Howles CM. Low dose FSH therapy for anovulatory infertility associated with polycystic ovary syndrome: rationale, reflections and refinements. Hum Reprod Update. 1999;5:493–9.
Guzick DS, Sullivan MW, Adamson GD, et al. Efficacy of treatment for unexplained infertility. Fertil Steril. 1998;70:207–13.
Hughes EG. The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility: a meta-analysis. Hum Reprod. 1997;12:1865–72.
Cohlen BJ, te Velde ER, van Kooij RJ, Looman CW, Habbema JD. Controlled ovarian hyperstimulation and intrauterine insemination for treating male subfertility: a controlled trial. Hum Reprod. 1998;13:1553–8.
Dare MR, Crowther CA, Dodd JM, Norman RJ. Single or multiple embryo transfer following in-vitro fertilization for improved neonatal outcome: a systematic review. Aust N Z J Obstet Gynaecol. 2004;44:283–91.
Wolner-Hanssen P, Rydhstroem H. Cost-effectiveness analysis of in-vitro fertilization: estimated costs per successful pregnancy after transfer of one or two embryos. Hum Reprod. 1998;13:88–94.
Hunault CC, Eijkmanans MJ, Pieters MH, et al. A prediction model for selecting patients undergoing in vitro fertilization for elective single embryo transfer. Fertil Steril. 2002;77:725–32.
Pandian Z, Marjoribanks J, Oztrk O, Serour G, Bhattacharya S. Number of embryos fro transfer following in vitro fertilization or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev. 2013;(7):CD003416.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Homburg, R. (2014). Multiple Pregnancies. In: Ovulation Induction and Controlled Ovarian Stimulation. Springer, Cham. https://doi.org/10.1007/978-3-319-05612-8_21
Download citation
DOI: https://doi.org/10.1007/978-3-319-05612-8_21
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-05611-1
Online ISBN: 978-3-319-05612-8
eBook Packages: MedicineMedicine (R0)