Is it worth reducing twins to singletons after IVF-ET? A retrospective cohort study using propensity score matching
Objective: Multifetal reduction of high-order multiple pregnancies has been shown to result in improved pregnancy outcomes.However,whether conducting elective fetal reduction from dichorionic twins after in vitro fertilisation and embryo transfer (IVF-ET)is worthwhile remains controversial.The present study was objected to answer the question whether elective fetal reduction from dichorionic twins to a singleton after IVF-ET associated with increased take-home baby rate and improved perinatal outcomes.Methods: A retrospective cohort study of 4084 dichorionic twin pregnancies after IVF-ET in a single centre between 2009 and 2015 was conducted.The reduced group included 71 women who underwent transvaginal elective fetal reduction between 7 to 8 weeks of gestation.The non-reduced group (n=3589) comprised patients who were managed expectantly without elective fetal reduction.We conducted propensity score matching to control for maternal age,occupation of the couples,parity,body mass index,infertility types,main causes of infertility,type of embryos that transferred and whether the embryos were frozen-thawed.The primary assessment of pregnancy outcomes was take-home baby rate.Other assessments included rates of adverse outcomes,early and late miscarriage and preterm delivery.Perinatal outcome measurements were gestational age,birth weight and neonatal defects.Results: After propensity score matching,the take-home baby rate was significantly lower in the reduced group than in the control group (83.1% vs.90.7%,OR 0.50,P=0.042).Respective rates of adverse outcomes in the two groups were 19.7% vs.13.5% (P=0.152).The miscarriage rate appeared to be higher in the reduced group,but the difference was not statistically significant.The rate of preterm delivery was lower in the reduced group (12.7% vs.46.3%,OR 0.17,P<O.001).Over 90% of preterm deliveries in the non-reduced group were over 32 weeks,whereas the proportions were equal in the reduced group.The respective median delivery ages were 38 weeks and 36 weeks in the reduced and non-reduced groups (P<0.001).Birth weight was significantly higher in the reduced than non-reduced group (median,3.0 vs.2.5 kg,P<0.001).Conclusion: Dichorionic twin pregnancies after IVF-ET with elective fetal reduction had a lower risk of preterm delivery after 32 weeks of gestation,but the chance of taking home at least one live baby was significantly decreased.Fetal reduction from dichorionic twins to a singleton after IVF-ET could be unnecessary for the purpose of maximizing chances of taking home at least one live baby.
dichorionic twin pregnancy elective fetal reduction in vitro fertilisation-embryo transfer take-home baby rate pregnancy outcome
Lu Luo Xiong-zhi Fan Hui-ying Jie Yong Gao Minghui Chen Can-quan Zhou Qiong Wang
The Center of Reproductive Medicine, Department of Obstetrics and Gynecology, First Affiliated Hospi Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University,
国内会议
广东惠州
英文
230-241
2017-07-14（万方平台首次上网日期，不代表论文的发表时间）