Factors determining early pregnancy loss in singleton and multiple implantations

Factors determining early pregnancy loss in singleton and multiple implantations

The incidence of first trimester pregnancy loss is much lower in IVF twin pregnancies than in IVF singleton pregnancies. The objective of this study was to determine which embryonic and maternal factors contribute to this finding. METHODS: Retrospective data analysis of the outcome of 1593 pregnanci...

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Bibliographic Details
Published in:Human reproduction (Oxford) Vol. 22; no. 1; pp. 275 - 279
Main Authors: Lambers, M.J., Mager, E., Goutbeek, J., McDonnell, J., Homburg, R., Schats, R., Hompes, P.G.A., Lambalk, C.B.
Format: Journal Article
Language:English
Published: England Oxford University Press 01-01-2007
Oxford Publishing Limited (England)
Subjects:
Abortion, Spontaneous - epidemiology
Abortion, Spontaneous - etiology
Adult
Biological and medical sciences
Cryopreservation
Embryo Transfer
Female
Fertilization in Vitro
Gynecology. Andrology. Obstetrics
Humans
Maternal Age
Medical sciences
Netherlands - epidemiology
Pregnancy
Pregnancy Outcome
Pregnancy Trimester, First
Pregnancy, Multiple
Regression Analysis
Retrospective Studies
Risk Factors
Sperm Injections, Intracytoplasmic
Twins
Netherlands
IVF
implantation
pregnancy loss
gestational sac
twin
In vitro fertilization embryo transfer
Multiple implantation
Vertebrata
Early pregnancy factor
gestational sac/implantation/IVF/pregnancy loss/twin
Mammalia
Pregnancy disorders
Ovum implantation
Assisted procreation
Abortion
Twin pregnancy
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Summary:The incidence of first trimester pregnancy loss is much lower in IVF twin pregnancies than in IVF singleton pregnancies. The objective of this study was to determine which embryonic and maternal factors contribute to this finding. METHODS: Retrospective data analysis of the outcome of 1593 pregnancies after day 3 double-embryo transfer (DET) after IVF or ICSI treatment. RESULTS: Of 1148 single implantations at 6 weeks, 936 (81.5%) were ongoing pregnancies. Of 445 multiple implantations at 6 weeks, 354 (79.6%) were ongoing multiple pregnancies, 80 (17.9%) were ongoing singleton pregnancies and 11 (2.5%) ended in a spontaneous abortion. Total pregnancy loss was 18.5 and 2.5% (P < 0.001) in singleton and twin gestations, respectively. Loss per gestational sac was 18.5 and 11.46% (P < 0.001), respectively. Determinants contributing to the continuation of gestation beyond 6 weeks were young maternal age, possibility to cryopreserve embryos and short GnRH agonist flare-up stimulation protocol. Whereas factors promoting multiple implantation at 6 weeks of gestation were young maternal age, high cumulative embryo score (CES), male infertility, long stimulation protocol and thick endometrium. CONCLUSIONS: Although multiple implantation at 6 weeks is predominantly determined by (morphological) embryo quality, the continuation of pregnancy beyond 6 weeks becomes more dependent on the combination of genetic and developmental potential of the embryo(s) and an optimal uterine milieu.
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ISSN:0268-1161
1460-2350
DOI:10.1093/humrep/del367