Comparison of the Outcomes Between Reduced and Nonreduced Triplet Pregnancies Achieved by Assisted Reproductive Technology

ABSTRACTWith assisted reproductive techniques (ARTs), embryos are transferred using in vitro fertilization (IVF). Increasing the number of embryos transferred can increase the likelihood of successful implantation and is perceived to maximize the success of pregnancy. The procedures have resulted in a large increase in the incidence of multiple pregnancies, which are associated with an increased risk of maternal and fetal complications and may have significant emotional, social, and financial implications. In addition to transferring fewer embryos, multifetal pregnancy reduction (MFPR) is used to reduce fetal number and improve survival of the remaining fetuses. This study was conducted to compare the outcomes of triplet pregnancies managed expectantly with those in which fetal reduction was performed.The population included 115 trichorionic triplet pregnancies conceived with ART during 2006 to 2012. Medical records of 57 triplet gestations reduced to twins (reduced group) and 58 triplets managed expectantly (nonreduced group) were reviewed. All parturients were counseled about the potential risks of fetal reduction and underwent prenatal screening tests and an ultrasound scan to determine the number, chorionicity, and position of the fetuses. Reduction procedures were performed at 11 to 14 weeks’ gestation by transabdominal injection of KCl solution into the fetal heart under ultrasound guidance. The main outcome measures were fetal loss at less than 24 weeks’ gestation, preterm labor, gestational age at delivery, neonatal birth weight, perinatal mortality rate, live birth rate, and admission to the neonatal intensive care unit. Perinatal mortality was defined as deaths occurring from week 24 to day 7 after delivery. All deliveries at 24 to 34 weeks’ gestation were considered preterm and those at more than 24 and less than 28 completed weeks were considered extremely preterm.The mean maternal age was 30.4 ± 4.3 years, and the mean duration of infertility was 7 ± 4.2 years. Indications for IVF were ovulatory factors (21%), tubal disease (3.5%), unexplained infertility (16.5%), male factors (45.2%), and other conditions (13.8%). Eighty-five women (73.9%) conceived by IVF/intracytoplasmic sperm injection and 30 (26.1%) by intrauterine insemination. Fetal loss at less than 24 weeks did not differ between groups. Preterm labor occurred in 15 women (26.3%) in the reduced group and in 29 women (50%) in the nonreduced group (P = 0.009). The rate of prematurity wa