EMBRYONAL REDUCTION USING TRANSVAGINAL SALINE INJECTION IN A SEXTUPLET PREGNANCY AFTER OVULATION INDUCTION WITH HUMAN MENOPAUSAL GONADOTROPIN

A sextuplet pregnancy occurred in a first treatment cycle of ovulation induction with human menopausal gonadotropins. The serum 17-beta-estr adiol concentration was 1245 pg/ml on the day of human chorionic gonad otropin administration. Embryonal reduction of four fetuses was carrie d out at nine weeks gestation using a transvaginal ultrasound-guided a pproach. Under general anesthesia, a 16-gauge in vitro fertilization n eedle was introduced through the posterior fornix and uterine wall, in to the nearest gestational sac. The embryo was penetrated and 0.9% sal ine solution was injected until disintegration was noted, and confirme d by a lack of pulse for more than two minutes. The same procedure was applied to the three embryos in closest proximity to the needle. The patient delivered healthy twins in the 34th week of gestation after ha ving had pre-term contractions for two weeks.