The alarming rise in multiple pregnancies resulting from the use of assisted reproductive technologies (ARTs) has led to many publications highlighting the significant maternal, fetal and neonatal risks associated with these pregnancies.

1. Dr. Laxmi Shrikhande
MD; FICOG; FICMCH;FICMU
 Director-Shrikhande Fertility Clinic, Nagpur
 Senior Vice President FOGSI 2012
 National Corresponding Editor-Journal of OB/GY of India
 Peer Reviewer-The Journal of OB / GY of India
 Publications-Eleven National & seven International
 Presented Papers at FIGO,SAFOG,AOFOG,AICC RCOG
 Editor-FOGSI Focus on SUI
 Received Best committee award of FOGSI
 Received Bharat Excellence award

2. Multiple pregnancy after
ART
Dr Laxmi Shrikhande
Director-Shrikhande Fertility Clinic,
Nagpur, INDIA

3. Why so much concern?
• undesirable complication of ovulation induction
and/or ovulation enhancement
• constitute an important health problem due to
high perinatal risks and increased health costs.

4. Is it different from
natural multiple gestation??
• retrospective analysis
• 106 IVF group and 256 spontaneous twin pregnancies
• The mothers in the IVF group were significantly older than those in the
control group (32±4 years vs 28±4 years, P<0.05).
• The incidence rates of gestational hypertension and gestational
diabetes in the IVF group were significantly higher than in the
control group (P<0.05).
• No significant differences were observed for neonatal physical development,
the incidence of birth defects, and the incidence and mortality of perinatal
diseases (P>0.05).
CONCLUSIONS:
• Twins conceived by IVF have similar outcomes as spontaneously
conceived twins in the perinatal period.
• However, special attention is needed to monitor the levels of blood
pressure and blood glucose for pregnant women with twins conceived by
IVF during prenatal checkups.
Zhongguo Dang Dai Er Ke Za Zhi. 2015

5. Prevention is better than cure!!!
• All efforts should be made to assure a singleton
birth when treating infertility.
• Tight rope walk for IVF consultants
• Risk of multiple pregnancy vs the success
rate/cycle
Reprod Biomed Online. 2014

6. IUI-When to cancel the cycle

7. How many embryos???
• Elective single embryo transfer (eSET) is
advocated in most European countries.
• In Belgium and Sweden, eSET is mandatory for
couples with a good prognosis.
• However, despite clinical recommendations and
policy statements, patients in clinical practice
frequently do request for the transfer of multiple
embryos in order to have twins.
Ann Med Health Sci Res. 2015 Jan-Feb;5(1)

8. Twins even after SET???
• To compare monozygotic twinning (MZT) rates in patients undergoing
blastocyst or cleavage-stage ET.
• Retrospective cohort.
• Autologous, fresh IVF cycles resulting in a clinical pregnancy
• There were a total of 9,969 fresh transfer cycles resulting in a pregnancy
during the study period.
• Of these pregnancies, 234 monozygotic twin pregnancies were identified
(2.4%).
• Of all transfers, 5,191 were cleavage-stage and 4,778 were blastocyst-stage
transfers.
• There were a total of 99 MZT identified in the cleavage-stage group
(1.9%) and 135 MZT in the blastocyst ET group (2.4%), which
was significant.
• When controlling for patient age, time period during which the cycle took
place, the number and proportion of six- to eight-cell embryos, and
availability of supernumerary embryos, there was no longer a
difference in MZT rate between blastocyst and cleavage transfer.
Fertil Steril. 2015 Jan;103(1):95-100

9. Management
• Selective fetal reduction
• Same as that for non ART twins
• Vaginal infection
• Steroids
• Good monitoring
• Multidisciplinary approach

10. Summary
• Is it different?
• Is it preventable?
• How to prevent?
• Is eSET is solution to
all the problems?
• How to balance ??
ASRM guidelines

11. Take Home Message
• All efforts should be made to assure a singleton
birth when treating infertility.
• Tight rope walk for IVF consultants
• Risk of multiple pregnancy vs the success
rate/cycle
Reprod Biomed Online. 2014