A TRIPLET PREGNANCY AFTER IN-VITRO FERTILIZATION IS A PROCEDURE-RELATED COMPLICATION THAT SHOULD BE PREVENTED BY REPLACEMENT OF 2 EMBRYOS ONLY

Objective: To investigate whether the incidence and obstetric outcome of triplet pregnancies after IVF treatment justify strict limitation o f the number of embryos to be replaced to two. Design: Retrospective a nalysis. Setting: A transport IVF program. Patient(s): All patients wh o had more than one embryo replaced, Intervention(s): None. Main Outco me Measure(s): Obstetric outcome, pregnancy. Result(s): High-order pre gnancies occurred in 24 cases (23 triplets and I quadruplet). Three pa tients opted for selective embryo reduction (12.5%). Three triplet pre gnancies spontaneously I educed to twins. Comparison of Is triplets, r eaching at least 20 weeks' gestation, with 54 twin pregnancies shows a higher perinatal mortality in the triplet group, causing 6 out of 18 patients to be confronted with at least one perinatal death. Triplets were born at a lower gestational age, had a lower birth weight, and a higher hospital admission rate of longer duration. Replacement of two, three, or four embryos did not lead to differences in pregnancy rates in the population studied. When a pregnancy occurred after replacemen t of three embryos, the risk of having a triplet pregnancy was 7.5%. C onclusion(s): The obstetric outcome of triplet pregnancies in our popu lation indicates that triplet pregnancies after IVF treatment have to be prevented. Selective embryo reduction is acceptable for few patient s only and can therefore not be seen as a solution. Replacement of thr ee embryos results in triplet pregnancy in an unacceptably high percen tage. Replacement of two embryos only gives acceptable IVF results and is the method chosen in the IVF program in Rotterdam to prevent tripl et pregnancies.