Early transvaginal embryo aspiration: a safer method for selective reduction in high order multiple gestations

Assisted reproduction technologies and ovulation induction for treatment of infertility continue to cause high order multiple gestations. Increased pe rinatal morbidity and mortality, as well as maternal morbidity, may complic ate these pregnancies. Selective fetal reduction, an acceptable therapeutic approach in these cases, is usually performed at or after the ninth week o f gestation, with KCI injected in the vicinity of the fetal heart, and is a ssociated with a total pregnancy loss rate of 11.7%, We report our experien ce with 90 women who underwent early (mean 7.5 weeks gestation, range 7.0-8 .0 weeks) transvaginal selective embryo aspiration. The mean number of viab le embryos before and after reduction was 3.5 and 2.1 respectively, Six (6. 7%) pregnancies were lost before 24 gestational weeks. One miscarriage occu rred at the tenth gestational week, The other five pregnancies were aborted at 17.3-21.6 weeks gestation. Additional interventions were performed in t hree of these pregnancies: genetic amniocentesis in two cases and cervical suture in one case. In the subset of 39 patients with 24 embryos, only one (2.6%) pregnancy loss was recorded. This loss rate is significantly lower ( P < 0.05) than the 15.3% loss rate in patients with 24 fetuses calculated f rom other work. Four (4.4%) other pregnancies were complicated by premature delivery (25-28 weeks gestation). Mean gestational age of delivered pregna ncies in our series was 35.7 weeks. In conclusion, early transvaginal embry o aspiration is a simple and relatively safe method for multiple pregnancy reduction. The overall pregnancy loss rate associated with early embryo asp iration is similar to that of procedures performed at later gestational age , but is significantly lower when the initial number of embryos is four or greater.