Opting for Twins in In Vitro Fertilization

2016 ◽  
Author(s):  
Bonnie Steinbock
Keyword(s):  
Learning Disabilities ◽  
Multiple Pregnancy ◽  
Reproductive Technology ◽  
Multiple Births ◽  
Fertility Treatment ◽  
Ethical Question ◽  
Multiple Pregnancies ◽  
Vitro Fertilization ◽  
Twin Pregnancies

Multiple births are an unfortunate consequence of assisted reproductive technology, causing risks to both fetuses and pregnant women. The central ethical issue raised by multiple pregnancy is the conflict between the fertility patient’s desire to get pregnant and the increased risks to offspring. Although extreme cases in which many embryos are transferred to the woman’s uterus are very rare—and represent negligence—twin pregnancies are still common. Many women undergoing fertility treatment reportedly express a preference for twin pregnancies to reduce the costs and risks of the procedure while increasing their opportunities for having more than one child. However, risks to the offspring are significant and underappreciated, including prematurity, low birth weight, cerebral palsy, and learning disabilities. Even though many multiple pregnancies result in good outcomes, the ethical question is whether the risks are justifiable in order to improve the chances of pregnancy when transfer of a singleton embryo is an available alternative.

scholarly journals Antenatal fetal death in multiple pregnancy: is early prediction possible?

2021 ◽  
Vol 14 (6) ◽  
pp. 602-611
Author(s):  
V. I. Tsibizova ◽  
D. V. Blinov ◽  
V. O. Bitsadze ◽  
T. M. Pervunina ◽  
E. V. Komlichenko ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Reference Values ◽  
Fetal Death ◽  
Multiple Pregnancy ◽  
First Trimester ◽  
Multiple Pregnancies ◽  
Vitro Fertilization ◽  
Diagnostic Potential ◽  
Increased Risk

Introduction. Perinatal mortality in multiple pregnancies increases by 8–10 times compared to singletons. Stillbirth is a significant part of all complications of multiple pregnancies. Although the incidence of perinatal mortality in multiple pregnancies has decreased consistently compared to extremely high rates in the past, it remains relatively high, despite significant positive changes in the management of such pregnancies. Aim: to assess the diagnostic potential of the first trimester's biochemical screening in multiple pregnancies for predicting antenatal fetal death. Materials and Methods. As part of a retrospective study, a cohort of twin pregnancies after in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or spontaneous conception underwent screening of the first trimester at 11+0–13+6 weeks of gestation as recommended by the Fetal Medicine Foundation. Determination of pregnancy-associated plasma protein-A (PAPP-A) in blood serum with subsequent calculation of the relative PAPP-A MoM (multiples of median) – a multiple of the median (an indicator of how much the individual test result deviates from the reference values) was performed. Results. Prenatal screening and outcomes of 302 multiple pregnancies showed that with PAPP-A MoM < 0.5, antenatal fetal death occurred with a frequency of 42.86 % (6/14), with PAPP-A MoM within the reference values – In 12.67 % (28/221), with PAPP-A MoM > 2.0 – in 6.7 % (2/30). Differences between patients with PAPP-A MoM < 0.5 and PAPP-A MoM within the reference values, as well as PAPP-A MoM < 0.5 and PAPP-A MoM > 2.0 were statistically significant (p = 0.002 and p = 0.004, respectively). No differences were detected between spontaneous and assisted reproductive technology (ART) pregnancies. Conclusion. In women with multiple pregnancies resulting from ART or spontaneous, PAPP-A MoM values below the reference interval (< 0.5) in the first trimester are associated with an increased risk of antenatal fetal death.

scholarly journals Perinatal outcomes of multiple births conceived through in vitro fertilization compared with spontaneous multiple births

2018 ◽  
Vol 51 ◽  
pp. 02008
Author(s):  
Irisa Zile ◽  
Inga Jefremova ◽  
Iveta Gavare
Keyword(s):  
In Vitro Fertilization ◽  
Congenital Anomalies ◽  
Perinatal Outcomes ◽  
Perinatal Period ◽  
Population Based ◽  
Multiple Births ◽  
Control Group ◽  
Multiple Pregnancies ◽  
Vitro Fertilization

Pregnancies that occur after assisted reproduction procedures constitute high-risk pregnancies. There is a lack of sufficient epidemio-logically based data on this issue in Latvia. The aim of this study was to compare the maternal and perinatal outcomes of multiple pregnancies conceived by in vitro fertilization (IVF) in comparison with spontaneous multiple pregnancies. This retrospective cohort study (2007–2014) analysed data from population-based Medical Birth Register (MBR). There is a statistically significant increase of multiple births from IVF pregnancies – an average 2% per year (p< 0.01). Newborns of IVF multiple births have higher odds of low birth weight (OR = 1.2) and congenital anomalies (OR = 1.6). Maternity characteristics showed that mothers in the IVF group were significantly older than those in the control group (≥35 years) (OR = 2.1) and primipara births (OR = 4.1). Multiple births conceived by IVF have similar outcomes as spontaneously conceived multiples in the perinatal period, although the rates of congenital anomalies after IVF are just slightly higher than in control group.

scholarly journals Hearing function in twins from spontaneous and induced pregnancy

2019 ◽  
Vol 64 (5) ◽  
pp. 49-54
Author(s):  
I. V. Rakhmanova ◽  
L. G. Sichinava ◽  
S. Yu. Lebedeva
Keyword(s):  
Otoacoustic Emissions ◽  
Assisted Reproductive Technologies ◽  
Multiple Pregnancy ◽  
Reproductive Technologies ◽  
High Risk Group ◽  
Multiple Pregnancies ◽  
Auditory Function ◽  
Vitro Fertilization ◽  
Distortion Product

In recent years, an increase in the frequency of multiple pregnancies has been observed worldwide, which is primarily associated with the widespread use of assisted reproductive technology for the treatment of infertility. Pregnancy resulting from in vitro fertilization is a high-risk group. In the world scientific literature there are practically no works on the study of auditory function in children from multiple pregnancy. As for the studies of the auditory function of children from multiple pregnancies, such works are practically absent in the literature. The article presents the results of an audiological examination of 204 children from twins, 94 of which were born as a result of using assisted reproductive technologies, and 110 from a spontaneous multiple pregnancy. According to an audiological survey using the method of otoacoustic emission at the frequency of product distortion in the expected period of labor, we have proven that the conception method (spontaneous or induced) does not affect the maturation of the auditory function in children from twins: registration of the distortion product otoacoustic emissions (DPOAE) test is 56,1 and 54,4% of cases, respectively. The auditory function of each child from one twin must be considered individually.

Specific characteristics of multiple pregnancies after in vitro fertilization

2020 ◽  
Vol 19 (5) ◽  
pp. 114-123
Author(s):  
S.A. Kalashnikov ◽  
Keyword(s):  
Birth Weight ◽  
In Vitro Fertilization ◽  
Premature Birth ◽  
Multiple Pregnancy ◽  
Research Problem ◽  
Reproductive Age ◽  
Extremely Low Birth Weight ◽  
Multiple Pregnancies ◽  
Vitro Fertilization

Multiple pregnancy is currently considered an important social and research problem, because it is often associated with a number of complications, such as premature birth and extremely low birth weight. Multiple pregnancies are facilitated by late reproductive age of the mother and in vitro fertilization (IVF) with the transfer of several embryos. In this review, we analyze specific characteristics of multiple pregnancies after IVF. Key words: twins, neonatal outcomes, in vitro fertilization

scholarly journals FEATURES OF THE COURSE OF MULTIPLE PREGNANCY AGAINST THE BACKGROUND OF FETAL GROWTH RETARDATION

2020 ◽  
Vol 8 (4) ◽  
pp. 433-438
Author(s):  
A.B. Sukharev ◽  
T.V. Kopytsia ◽  
V.I. Boyko
Keyword(s):  
Pregnant Women ◽  
Fetal Growth ◽  
Multiple Pregnancy ◽  
Placental Insufficiency ◽  
Multiple Births ◽  
Growth Delay ◽  
Control Group ◽  
Multiple Pregnancies ◽  
Group I

In most European countries in recent years, the frequency of multiple births ranges from 11 to 14 per 1000. These pregnancies have a high number of complications. Perinatal mortality in multiple births is more than 6 times higher than in singleton pregnancies. Severe neurological abnormalities under the age of 1 year have from 10% to 25% of twins. According to most researchers, the main cause of perinatal losses in multiple births is deep prematurity and severe fetal growth delay. It has now been proven that placental insufficiency is the main reason of developmental delay, discordant fetal growth, antenatal death of one of the fetuses. A fetus that develops and is born in conditions of chronic placental insufficiency is more vulnerable and at high risk of developing perinatal pathology. The purpose of the research was to study the frequency and structure of complications of the pregnancy and labor of women with multiple pregnancies, complicated uteroplacental insufficiency and fetal discordance. The study was carried out at the city clinical maternity house during 2013–2019. The information was gathered from literature and by interviewing pregnant women with twins. 20 pregnant women (group I) with dichorionic, diamnionic twins with the presence of placental insufficiency and fetal discordance of more than 20%. Group II consisted of 20 pregnant women with twins but fetal discordance did not exceed 20%. However, the control group ІІІ consisted of 30 women without complications and ended in physiological labor. The general, somatic, obstetric and gynecological anamnesis, especially the course of pregnancy, childbirth, the state of the cervix by vaginal and ultrasound examination were studied. The results of the study show that in the anamnesis of pregnant women with fetal discordance, take place in vitro fertilization and infections of the respiratory and urinary tract. Multiple pregnancies which were accompanied by fetal discordance exceeding 20% ​​is accompanied by impaired uteroplacental circulation. Labor with twins complicated by impaired uteroplacental circulation occurs in a large number of complications. The results can be applied to the using various medications for the correction of disorders of the uteroplacental circulation.

scholarly journals The Octo Mom Meets Constitutional Law: Testing the Constitutionality of Restricting Fertility Treatments

2011 ◽  
Vol 5 ◽  
Author(s):  
Theresa Miller-Sporrer
Keyword(s):  
In Vitro Fertilization ◽  
Constitutional Law ◽  
Fertility Treatment ◽  
Multiple Pregnancies ◽  
Financial Situation ◽  
Vitro Fertilization ◽  
The Public ◽  
Fertility Treatments

On 26 January 2009, Nadya Suleman gave birth to eight children. 1 The public outpouring of support quickly turned into widespread condemnation as more information about Ms. Suleman’s multiple pregnancies and financial situation was released.2 Once the public learned not only that Ms. Suleman had six other children but also that all fourteen children had been conceived using in vitro fertilization, the public began to question both her judgment and the judgment of her doctor.3 The public apparently was willing to accept the birth if it was the non-deliberate product of a hormone-based fertility treatment but was less willing to accept the birth if it was the result of a deliberate choice on the part of Ms. Suleman and her physician.

Management and outcome of high-order multiple pregnancy

1996 ◽  
Vol 8 (3) ◽  
pp. 133-142
Author(s):  
Shlomo Lipitz ◽  
Dan Grisaru ◽  
Zeev Rotstein ◽  
Reuwen Achiron
Keyword(s):  
Multiple Pregnancy ◽  
Neonatal Morbidity ◽  
High Order ◽  
Multiple Pregnancies ◽  
Maternal Complications ◽  
Vitro Fertilization ◽  
Increased Risk ◽  
High Prevalence ◽  
Need To Evaluate

The incidence of pregnancies with three or more fetuses has markedly increased over the past two decades. The change has been attributed to the introduction and widespread use of new techniques for ovulation induction and placement of multiple embryos during in vitro fertilization (IVF). These techniques have been a matter of concern, since triplet and higher multiple pregnancies have long been associated with an increased risk of maternal complications, and a high prevalence of perinatal and neonatal morbidity and mortality. Furthermore, the developing experience with multifetal pregnancy reduction offers a new option for the management of these pregnancies. There is therefore a need to evaluate the management and outcome of high-order multiple pregnancies.

Follicular fluid and assisted reproductive technology programs outcomes (literature review)

GYNECOLOGY ◽  
2020 ◽  
Vol 21 (6) ◽  
pp. 36-40
Author(s):  
Anna G. Burduli ◽  
Natalia A. Kitsilovskaya ◽  
Yuliya V. Sukhova ◽  
Irina A. Vedikhina ◽  
Tatiana Y. Ivanets ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Assisted Reproductive Technology ◽  
Follicular Fluid ◽  
Economic Cost ◽  
Reproductive Technology ◽  
Art Programs ◽  
Vitro Fertilization ◽  
Non Invasive ◽  
Established Fact

The review presents data on metabolites in the follicular fluid (FF) from the perspective of reproductive medicine and their use in order to predict outcomes of assisted reproductive technology (ART) programs. It considers various components of this biological medium (hormones, lipids, melatonin, etc.) with an assessment of their predictive value in prognosis of the effectiveness of in vitro fertilization (IVF) programs. The data on experimental directions in this field and the prospects for their use in clinical practice are presented. The article emphasizes that the growing clinical need and the unsolved problem of increasing the effectiveness of ART programs determine the need for further studies of the FF composition. Materials and methods. The review includes data related to this topic from foreign and Russian articles found in PubMed which were published in recent years. Results. Given the established fact of a direct effect of FF composition on growth and maturation of oocytes, and further, on the fertilization process, various FF metabolites are actively investigated as non-invasive markers of quality of oocytes/embryos. The article provides data on the experimental directions in this field and the prospects for their use in clinical practice. However, clinical studies of a relation between various FF metabolites levels and outcomes of IVF programs are contradictory. Conclusion. Owing large economic cost for treatment of infertility with IVF, there is need for expansion and intensification of studies to identify and use reliable predictors in prognosis of ART programs outcomes.

How Does the Inclusion of Twins Conceived via Fertility Treatments Influence the Results of Twin Studies?

2012 ◽  
Vol 15 (6) ◽  
pp. 746-752 ◽  
Author(s):  
S. Alexandra Burt ◽  
Kelly L. Klump
Keyword(s):  
Twin Studies ◽  
The United States ◽  
Fertility Treatment ◽  
State University ◽  
Behavioral Differences ◽  
Vitro Fertilization ◽  
Fertility Treatments ◽  
Control And Prevention ◽  
Twin Families

Rates of twinning have risen dramatically over the last 30 years, from 1 in 53 births in 1980 to 1 in 30 births in 2009 (Martin et al. (January 2012). Three decades of twin births in the United States, 1980–2009. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Health Statistics). This increase is largely attributable to increases in the use of fertility treatments (i.e., ovulation induction and in vitro fertilization) combined with delays in parenthood. Although this increase means that more twins are available for recruitment into twin studies, it also has potential consequences for the heritability estimates obtained in these studies. This study sought to evaluate this possibility, making use of the ongoing Michigan Twins Project (N = 7,261 families with twins aged 3–17 years), an arm of the Michigan State University Twin Registry. Results revealed that, on average, twins conceived via fertility treatments had lower rates of behavior problems than those conceived naturally, although these behavioral differences could be explained largely by demographic and socio-economic differences across the two types of twin families. Twin similarity did not meaningfully differ across fertility treatment status. We thus conclude that estimates of genetic and environmental influences obtained from twin studies over the last 10–15 years are more or less unaffected by the inclusion of twins conceived via fertility treatments in their samples.

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