Am J Obstet Gynecol MFM. 2021 Oct 23:100521. doi: 10.1016/j.ajogmf.2021.100521. Online ahead of print.
ABSTRACT
Infertility treatments have benefited millions of couples to have their own children, but resultant multiple pregnancies with their increased morbidity and mortality have been a significant complication. Fetal reduction (FR) was developed to ameliorate those. Over 30 years of publications show that FR has been highly successful in substantially reducing both mortality and morbidity. As with most radically new techniques, initial cases were in the “nothing to lose” category. With experience, indications liberalize, and quality of life issues increase as a proportion of cases. Overall risks for twins are not twice singletons; they are about 4 – 5 x higher. In experienced hands, the combination of genetic testing by CVS followed by FR has made most multiples behave statistically as if they were originally the lower number. Use of microarray analysis to better determine fetal genetic health before deciding on which fetus(es) to keep or reduce further improves pediatric outcomes. With increasing experience and lower average starting numbers, the proportion of FRs to a singleton has increased considerably. Twins to a singleton FR now constitute an increasing proportion of cases performed. Data on such cases show improved outcomes, and we believe FR should be at least discussed and offered to all patients with a dichorionic twin pregnancy or higher. With increasing reliance upon elective single embryo transfer (eSET), monochorionic twins have substantially increased which have much higher complication rates than dichorionic twins. Furthermore, monochorionic twins cannot be readily, safely reduced so the adverse perinatal statistics of eSET are a major set-back for good outcomes. While eSET is appropriate for some, we believe that for many couples, transfer of 2 embryos is generally a more rational approach.
PMID:34700026 | DOI:10.1016/j.ajogmf.2021.100521
