B. Brambati et al., MULTIPLE PREGNANCY INDUCTION AND SELECTIVE FETAL REDUCTION IN HIGH GENETIC RISK COUPLES, Human reproduction, 9(4), 1994, pp. 746-749
Couples at risk for an inherited disorder often have several pregnancy
interruptions because of affected fetuses and difficulty in achieving
their desired family. We evaluated the efficiency and acceptability o
f selective fetal reduction after chorionic villus sampling (CVS) of m
ultiple pregnancy induced by ovarian stimulation and gamete intra-Fall
opian transfer (GIFT). This approach has been offered to nine patients
at risk of Mendelian diseases and one patient carrier of reciprocal t
ranslocation. The acceptance has been very high (90%). One patient at
risk of an autosomic recessive disease opted for artificial donor inse
mination, one conceived spontaneously, and one was a poor responder to
ovarian stimulation. Seven patients actually underwent a single GIFT
procedure with six achieving pregnancy (86%), all but two being a mult
iple pregnancy (67%). Ah pregnancies concluded uneventfully at term an
d newborns were alive and healthy. Prenatal diagnosis, including fetal
karyotyping in all cases, was performed at 8.5-11.5 weeks of gestatio
n and confirmed either on amniotic fluid aspirated at reduction or at
birth. The number of fetuses was reduced to one or two because the gen
etic disease was present and/or to reduce the risk of premature delive
ry and improve the likelihood of successful pregnancy. The new approac
h seems to be highly effective and might be considered a practical and
useful alternative to preimplantation genetic diagnosis.