Successful Outcome of 152 High Order Multifetal Pregnancies after Transvaginal Embryo Reduction and Comparison with Nonreduced

Objective: We aimed to assess the safety of transvaginal route for multifetal pregnancy reduction (MPR) early in the first trimester. Design: Retrospective study Setting: Antalya IVF Patients: Hundred and fifty two high order multifetal pregnancies (HOMP) which occurred by assisted reproductive technology (ART) and underwent MPR constituted the study population and 130 primary dichorionic diamniotic ART twins constituted the control group. Interventions: All HOMPs were reduced to twins within 8th week of gestation. Embryo(s) with smaller crown-rump length or with weaker heart activity were preferred to be eliminated. A maximum volume of 2 ml of 2 mEq/ml KCl was injected into the fetal thorax until the cessation of fetal heart movements was observed. Main Outcome measures: The complete pregnancy loss rate Results: The complete pregnancy loss rate <24 weeks of gestation in MPR group and the control group was 6.6% and 6.9% respectively. When outcome parameters were also assessed in relation to the initial number of embryos; complete pregnancy loss rates, vanishing embryo rates, successful pregnancy rates, preterm delivery rates, severe preterm delivery rates, birth weight discordance rates were all similar for the MPR group and the control group. Only one loss out of 152 reduction cases occured within four weeks after MPR. Conclusions: In the present study,. transvaginal route with intrathoraric KCl injection seems to be a safe method for first trimester MPR. Due to its success, safety and possible less psychological burden, we believe that performing the MPR transvaginally at 8th weeks should be the preferred method in ART practice.