Obstetric outcome and psychological follow-up of pregnancies after embryo reduction

The obstetric outcome and psychological follow-up of the parents after embr yo reduction performed at Sahlgrenska University Hospital between 1993 and 1997 in 13 women treated for infertility is described. A comparison is made with non-reduced multiple pregnancies, both spontaneous and multiple pregn ancies after assisted reproduction technology. Altogether 10 triplets, two quadruplets and one quintuplet pregnancy underwent embryo reduction. The su rgical procedure was performed in gestation week 7-8 by transvaginal, ultra sound-guided aspiration of embryonic tissue. The psychological follow-up in cluded personal interviews and psychological evaluations by a Psychological General Well-being Scale (PGWB) and Beck's Depression Inventory (BDI), In 11 cases reduction was performed to twin pregnancies. In two cases of tripl ets after in-vitro fertilization and transfer of two embryos, reduction was performed on the monozygotic, monochorionic twins. No complete miscarriage s occurred. Ten women delivered twins and three women delivered singletons. The mean gestation length was 40.4 weeks for singletons and 35.9 weeks for twins. The mean birthweight was 3411 g for singletons and 2392 g for twins . No complications related to the reduction were detected in the children,T he psychological follow-up showed that the psychological well-being of the parents was good. However, the events around the reduction were experienced as chaotic and emotionally disturbing. One woman regretted the reduction. All couples emphasized that avoidance of high order pregnancies should be o f primary importance. In conclusion, embryo reduction appears to improve th e perinatal outcome of multiple pregnancies obtained after assisted reprodu ction technology. It is important that the surgical procedure is performed at a centre with experience of this type of intervention, by a limited numb er of surgeons and in a regulated manner. Psychologically, however, the int ervention is traumatic and psychological management is essential for good f inal outcome.