How Many Embryos should be Transferred? The Relevance of Parity and Obstetric History

Fertility treatments are responsible for the rise in high order pregnancies in recent decades and their associated complications. Reducing the number of embryos returned to the uterus will reduce the rate of high order pregnancies. To explore whether obstetric history and parity have a role in the c...

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Bibliographic Details
Published in:The Israel Medical Association journal 2016-06, Vol.18 (6), p.313-317
Main Authors: Goldberg, Doron, Tsafrir, Avi, Srebnik, Naama, Gal, Michael, Margalioth, Ehud J, Mor, Pnina, Farkash, Rivka, Samueloff, Arnon, Eldar-Geva, Talia
Format: Article
Language:English
Subjects:
Adult
Apgar Score
Delivery, Obstetric - statistics & numerical data
Embryo Transfer - adverse effects
Embryo Transfer - methods
Embryo Transfer - statistics & numerical data
Female
Fertilization in Vitro - adverse effects
Fertilization in Vitro - methods
Fertilization in Vitro - statistics & numerical data
Gestational Age
Humans
Infant, Low Birth Weight
Infant, Newborn
Israel - epidemiology
Parity
Pregnancy
Pregnancy Outcome - epidemiology
Pregnancy, Twin - statistics & numerical data
Premature Birth - epidemiology
Premature Birth - etiology
Reproductive History
Retrospective Studies
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Summary:Fertility treatments are responsible for the rise in high order pregnancies in recent decades and their associated complications. Reducing the number of embryos returned to the uterus will reduce the rate of high order pregnancies. To explore whether obstetric history and parity have a role in the clinician's decision making regarding the number of embryos transferred to the uterus during in vitro fertilization (IVF). In a retrospective study for the period August 2005 to March 2012, data of twin deliveries > 24 weeks were collected, including parity, mode of conception (IVF vs. spontaneous), gestational age at delivery, preeclampsia, birth weight, admission to the neonatal intensive care unit (NICU), and Apgar scores. A total of 1651 twin deliveries > 24 weeks were record- ed, of which 959 (58%) were at term (> 37 weeks). The early preterm delivery (PTD) rate (< 32 weeks) was significantly lower with increased parity (12.6%, 8.5%, and 5.6%, in women with 0, 1, and ≥ 2 previous term deliveries, respectively). Risks for PTD (< 37 weeks), preeclampsia and NICU admission were significantly higher in primiparous women compared to those who had one or more previous term deliveries. Primiparity and preeclampsia, but not IVF, were significant risk factors for PTD. The risk for PTD in twin pregnancies is significantly lower in women who had a previous term delivery and decreases further after two or more previous term deliveries. This finding should be considered when deciding on the number of embryos to be transferred in IV.
ISSN:1565-1088