Is there an indication for embryo reduction?

The selective reduction of embryos in multiple pregnancies poses numerous medical, technical, ethical and psycho-social problems. In a retrospective study, we analysed nine hundred and twenty-two pregnancies obtained using medically assisted procreation between May 1982 and May 1990. Among 922 successful pregnancies, 372 were singleton, 102 were twin and 13 were triplet. Data from this analysis and from a French multicentre study of 262 embryo reduction procedures demonstrated the value of an embryo quality score for minimizing the risk of multiple pregnancy and the existence of extremely infrequent, ethically acceptable indications for embryo reduction. These indications included ultrasound-proven malformations of one fetus, multiple pregnancies in patients with extensive uterine scarring, and multiple pregnancy despite the appropriate use of preventative measures which can be expected to make this technique unnecessary in the future.

The management of multiple pregnancies after induction for superovulation

The high rate of multiple pregnancies after embryo transfer depends upon the number of embryos replaced and amounts to approximately 20% for four or more embryos. This incidence justifies a preventive or curative treatment after the induction of superovulation. Aspiration of one or more embryos via the cervix under ultrasound control has been undertaken on 42 patients since 1983, and involved two sextuplets, 10 quadruplets, 18 triplets and 12 twins. Twenty six embryo reductions were performed before 9 weeks of amenorrhoea. Five failures after 9 weeks were due, in the early stages of this procedure, to infection. In the case of twins, the indication was a scarred uterus in 10 cases and a psychiatric reason for two patients. In 19% of our cases delivery occurred within 32 weeks of amenorrhoea.