Multiple gestation pregnancy

Multiple gestation pregnancy rates are high in assisted reproductive treatm ent cycles because of the perceived need to stimulate excess follicles and transfer excess embryos in order to achieve reasonable pregnancy rates. Per inatal mortality rates are, however, 4-fold higher for twins and 6-fold hig her for triplets than for singletons, Since the goal of infertility therapy is a healthy child, and multiple gestation puts that goal at risk, multipl e pregnancy must be regarded as a serious complication of assisted reproduc tive treatment cycles. The 1999 ESHRE Capri Workshop addressed the psycholo gical, medical, social and financial implications of multiple pregnancy and discussed how it might be prevented. Multiple gestations are high risk pre gnancies which may be complicated by prematurity, low birthweight, pre-ecla mpsia, anaemia, postpartum haemorrhage, intrauterine growth restriction, ne onatal morbidity and high neonatal and infant mortality. Multiple gestation children may suffer long-term consequences of perinatal complications, inc luding cerebral palsy and learning disabilities. Even when the babies are h ealthy they must share their parents' attention and may experience slow lan guage development and behavioural problems, Current data indicate that the average hospital cost per multiple gestation delivery is greater than the a verage cost of in-vitro fertilization (IVF) and intracytoplasmic sperm inje ction (ICSI) cycles. Prevention is the most important means of decreasing m ultiple gestation rates. Multiple gestation rates in ovulation induction an d superovulation cycles can be reduced by using lower dosage gonadotrophin regimens. If there are more than three mature follicles, the cycle should b e converted to an IVF cycle, or it should be cancelled and intercourse shou ld be avoided. In IVF cycles two embryos can be transferred without reducin g birth rates in most circumstances. Embryo reduction involves extremely di fficult decisions for infertile couples and should be used only as a last r esort. Assisted reproductive treatment centres and registries should expres s cycle results as the proportion of singleton live births; twin and triple t rates should be reported separately as complications of the procedures. R educing the multiple gestation pregnancy rate should be a high priority for assisted reproductive treatment programmes, despite the pressure from some patients to transfer more embryos in order to improve success. If nothing is done, public concern may lead to legislation in many countries, a step t hat would be unnecessary if assisted reproductive treatment programmes and registries took suitable steps to reduce multiple pregnancy rates.