- Email: [email protected]
P-94
first cycle donors who caused pregnancy trended toward increased success in subsequent cycles. However, the differences were not statistically significant, possibly due to the small sample size. If our findings become significant with a larger sample size and if confirmed by other centers, future selection criteria for oocyte donors may include a history of prior pregnancy or success in first donor cycle. Supported by: None.
P-92 EFFECT OF DURATION OF ESTROGEN TREATMENT ON IMPLANTATION AND PREGNANCY RATES IN AN EGG DONATION PROGRAM. J. Hernandez, V. Sanabria, V. Pen˜a, E. Chinea, R. Bennett, A. Palumbo. Centro de Asistencia a La Reproduccio´n Humana de Canarias, La Laguna, Tenerife, Spain; Westchester Reproductive Medicine, Yorktown Heights, NY. OBJECTIVE: The optimal duration of estrogen replacement for endometrial preparation in donor egg recipients is controversial. The aim of the present study is to determine whether the duration of estrogen treatment influences implantation and pregnancy rates in donor egg recipients. DESIGN: Retrospective database analysis. MATERIALS AND METHODS: Between January 2002 and March 2006, 148 egg donation cycles were performed in 112 patients between 29 and 54 years old. Ovulation induction in egg donors was carried out using either a downregulation or an antagonist protocol, with or without birth control pill pre-treatment. Recipients received either oral estradiol valerate or transdermal estradiol for a variable number of days depending on donor availability. Vaginal progesterone suppositories were started on the day of egg retrieval. Ultrasound guided embryo transfer was performed on day 3 in the great majority of cases (n⫽120), more rarely on day 2 (n⫽13) or 5 (n⫽15). The mean number of embryos transferred was 2.1, with 2 embryos transferred in most cases, 1 embryo in 13 cases and 3 embryos in 29 cases. Patients were divided into 2 groups based on duration of treatment: ⱕ 19 (range 9 to 19) and ⱖ 20 days (range 20 to 69). Differences were analyzed using the student t test and the X2 test. RESULTS: Overall, the clinical pregnancy rate (PR) per cycle was 56.1% the ongoing (⬎20 wks) PR per cycle was 40.5%. Results in the 2 groups are shown in the table below.
CONCLUSION: Our data show that duration of estrogen treatment does not affect implantation or pregnancy rates, allowing a great flexibility in an egg donation program. Increasing the number of patients, will permit the analysis of shorter time intervals, to confirm the present findings. Supported by: None.
P-93 THE INVOCELL, A NEW MEDICAL DEVICE FOR INTRA VAGINAL FERTILIZATION AND CULTURE. L. Bonaventura, P. Ahlering, R. Morris, J. Mouchel, M. Scheiber, J. Batzofin. Bonaventura Reproductive Medicine, Carmel, IN; SIRM St. Louis, Creve Coeur, MO; IVF1, Chicago, IL; Unite D’Aide Medicale a la Procreation Clinique du Tertre Rouge, Le Mans, France; Institute for Reproductive Health, Cincinnati, OH; SIRMNY, New York, NY.
S164
Abstracts
OBJECTIVE: The INVOcell is a device designed to achieve fertilization and early embryo development by incubating eggs, sperm and resulting embryos in the vagina. This clinical study was performed to evaluate the efficacy and safety of the INVOcell. DESIGN: Multicenter, non randomized, non comparative clinical trial. MATERIALS AND METHODS: Approximately 75 women younger than 38 years old will be treated at 6 IVF centers. To date 60 women have been enrolled. Severe endometriosis, egg donors and men with severe male factor necessitating ICSI were excluded. Controlled ovarian hyperstimulation was achieved using standard protocols. Egg retrieval was performed under IV sedation. To evaluate fertilization and embryo development in the INVOcell, no less than 4 eggs and no more than 10 eggs were placed with sperm in the inner part of the device with culture medium. In some patients excess eggs were inseminated using traditional IVF or ICSI techniques. The INVOcell inner chamber was inserted into an outer chamber and the completely assembled INVOcell device was placed in the vagina with a vented diaphragm to effect retention. The INVOcell remained in the vagina for 3 days. After 3 days the diaphragm and INVOcell were removed. The diaphragm was discarded and the INVOcell device was cleaned. The inner part of the device was then placed upright for 15 minutes in an incubator at 37 °C. After 15 minutes the embryos were collected from the microchamber at the base of the INVOcell and observed to determine their stage of development and quality. At this point 1 to 3 embryos were transferred into the uterus. Study endpoints include fertilization, embryo development and pregnancy rates. RESULTS: To date the first 29 procedures have been completed, resulting in 9 pregnancies (31%, ITT). The observed fertilization rate was 48% and the lead embryos were between 6 and 14 cells. Treatment of an additional 50 patients will be completed within the next few weeks and full clinical results, as well as a study on patient acceptance, will be available at the time of presentation. CONCLUSION: Fertilization and early embryo development were effectively achieved intra vaginally within the INVOcell device and several pregnancies are ongoing. This device reduces the need for complex laboratory equipment and provides multiple options for the physician and the IVF patient. Supported by: Medelle Corporation, Woburn, MA.
P-94 THE EFFECT OF BODY MASS INDEX ON IVF OUTCOME. J. P. Stassart, G. D. Ball. RMIA, Woodbury, MN. OBJECTIVE: The objective of this study was to evaluate the effect of Body Mass Index (BMI) on In Vitro Fertilization (IVF) outcomes. DESIGN: This was a retrospective analysis of patients undergoing routine IVF. Patients were grouped into 5 categories based on BMI: ⬍21 (group 1), 21-25 (group 2), 26-30 (group 3), 30-35 (group 4), and ⬎36 (group 5). None of the patients were diagnosed as having polycystic ovarian stimulation syndrome. All patients were less than 36 years of age at stimulation start. To control for possible confounding of embryo quality at transfer and BMI grouping, sub-analyses were performed that included only patients that received two “top quality” embryos at transfer. MATERIALS AND METHODS: All patients underwent ovarian stimulation with injectible gonadotropins and received hCG to induce final follicle maturation. A transvaginal oocyte retrieval was performed 36 hr post hCG injection. Fertilization was achieved either by insemination or ICSI and embryo transfer was performed on days 3, 4 or 5 post oocyte retrieval. At the time of transfer, Day 3 embryos were evaluated and assigned a quality score based on morphological characteristics (number of cells, blastomere multinucleation, degree of fragmentation, and blastomere symetry). Day 4 embryos were scored based on degree of compaction and symetry of compaction. Day 5 embryos were scored based degree of blastocoel formation, integrity of the inner cell mass and integrity of the trophoblast. Clinical pregnancy was defined as an intrauterine gestation sac with documentation of fetal heart beat. RESULTS: When all patients were included in the analysis, the clinical pregnancy rates for groups 1-5, respectively, were 47.1% (n⫽34), 54.8% (n⫽186), 48.9% (n⫽94), 40.4% (n⫽47), and 0% (n⫽9). The R2 value for the calculated linear regression was 0.61 (Figure 1). When inclusion criteria were limited to only patients that received two embryos graded as “top quality”, pregancy rates for groups 1-5, respectively, were 63.6% (n⫽11), 67.9% (n⫽53), 60% (n⫽25), 56.3% (n⫽16), and 0% (n⫽2). The R2 value for the calculated linear regression was 0.61 (Figure 2).
Vol. 86, Suppl 2, September 2006
P-96 COMPARISON OF THREE DIFFERENT OVARIAN STIMULATION PROTOCOLS FOR INTRAUTERINE INSEMINATION. G. K. Mansour, A. Agarwal, R. Mahfouz, J. M. Goldberg, R. K. Sharma, T. Falcone. Cleveland Clinic, Cleveland, OH.
CONCLUSION: Increasing BMI values appear to have a negative impact on pregnancy outcome for IVF. Supported by: None.
OBJECTIVE: Intrauterine insemination (IUI) is usually offered to infertile couples as an easy and inexpensive method especially if the female partner has patent and well developed fallopian tubes. The aim of our study was to assess the pregnancy rate, incidence of hyperstimulation syndrome and multiple pregnancies amongst patients treated with three different ovarian stimulation protocols used for intrauterine insemination. DESIGN: A retrospective study. MATERIALS AND METHODS: We reviewed the results of 1881 cycles of IUI from 677 patients treated at the Cleveland Clinic during 2003 - 2005. Three protocols were used for ovarian stimulation, Group I (n⫽129 patients, 267 cycles) were treated with Clomiphine citrate at a dose of 100 mg/day from day 3 till day 7 of the cycle; group II (n⫽353 patients, 828 cycles) were given highly purified FSH with different doses till reaching the proper follicular size (16-18 mm). Ovulation was triggered with 10,000 IU of human chorionic gonadotropin, and IUI was carried out 36 hours later. Patients in group III (n⫽195 patients, 786 cycles) were not given any medication for ovarian stimulation and considered as natural stimulation protocol. Luteal phase was not supported by exogenous progesterone. Statistical analysis was performed using Chi square, F-Fischer ANOVA and Student’s T-test. Multiple logistic regression analysis was performed to control for age, type and duration of infertility. RESULTS: The mean age was 31.6 ⫾5.4 years; the mean duration of infertility 3.06⫾1.8 years. All treatment groups were comparable in demographic and infertility characteristics. There were significant differences in pregnancy rates per cycle as well as the incidence of hyperstimulation and incidence of multiple pregnancy rate among the three groups (Table 1). Patients under 30 years old had a pregnancy rate per cycle of 26% compared to 22% in women between 30 and 35 years old, and 12% in women over 35 years old and 5.3% in women over 40 years old. In all the cycles, pregnancy rate was significantly higher in patients under 30 years of age (p⬍0.001).
P-95 EFFECT OF BODY MASS INDEX (BMI) AND/OR WEIGHT DISTRIBUTION ON IVF OUTCOME. D. E. Woodford, M. P. Grossman, L. T. Ku, H. C. Bohler, S. T. Nakajima. Univ of Louisville, Louisville, KY. OBJECTIVE: Determine whether BMI and/or weight distribution has an effect on IVF outcome DESIGN: Historical Cohort. MATERIALS AND METHODS: Women undergoing their first-attempt at controlled ovarian hyperstimulation for in vitro fertilization using a long GnRH-agonist stimulation protocol from 1/1/03 - 12/31/05. On day of oocyte retrieval weight, height, waist and hip circumferences were obtained. BMI and waist to hip ratio (WHR) were calculated. RESULTS: 205 women were analyzed. The overall clinical pregnancy rate for this group was 53%. BMI (kg/m2) ranged from 18.2 to 50.5 with mean (⫾SD) of 26.5 (⫾6.1). WHR range from 0.59 to 1.00 with mean (⫾SD) of 0.83 (⫾0.06). Neither parameter was associated with pregnancy outcome. Different subgroups of BMI (kg/m2) (normal:19-24.9, overweight ⫽25-29.9, obese 30-34.9, morbidly obese ⬎35) were analyzed and no differences in pregnancy rates were found. In a subgroup of women with only the diagnosis of ovulation disorder (n⫽21), the range for BMI (kg/m2) and WHR was 19.8-50.5 kg/m2 and 0.76-1.00, respectiviely. The mean (⫾SD) for BMI (kg/m2) and WHR were 29.5 kg/m2 (⫾ 8.0) and 0.86 (⫾ 0.07), respectively. The clinical pregnancy rate for this subgroup was 80%. There was no significant difference in BMI and/or WHR between women who achieved pregnancy and those who did not. CONCLUSION: 1)Although prior studies have suggested that obsese women have decreased fertility, there was no effect of BMI and/or weight distribution on IVF outcome in our population, 2) When ovulatory disorders are corrected, women had a higher pregnancy rate than the general population over a wide range of BMI and weight distributions. Supported by: The Woodson Foundation.
FERTILITY & STERILITY威
CONCLUSION: Although FSH increases the pregnancy rate per cycle in patients undergoing IUI, however, it also results in a significant increase in the rate of multiple pregnancies as well as hyperstimulation syndrome. The woman’s age plays an important role in predicting good IUI outcome regardless of the ovarian stimulation protocol used. Supported by: None.
P-97 FETAL REDUCTION TO SINGLETON: IS IT JUSTIFIED FOR ART MULTIFETAL PREGNANCIES? K. Ozgur, M. Isikoglu, M. Berkkanoglu. Antalya IVF, Antalya, Turkey. OBJECTIVE: Twin gestations have relatively increased rates of fetal and maternal complications and a twin pregnancy being regarded as an adverse outcome. (Land and Evers, 2003, report of an ESHRE consensus meeting). Although currently the only preventive measure for twin pregnancy is single embryo transfer, worldwide it has not been widely applied in IVF practice yet. Another measure to prevent twin pregnancies is to reduce multifetal pregnancies to singleton when it occurs. Therefore our center has offered multifetal pregnancies an option to reduce to singleton since 2004 and was accepted in a group of 43 patients. This study is aimed to assess the safety of early transvaginal multifetal pregnancy reduction (MPR) to singleton in multifetal ICSI pregnancies. DESIGN: Retrospective study.
S165
P-92 EFFECT OF DURATION OF ESTROGEN TREATMENT ON IMPLANTATION AND PREGNANCY RATES IN AN EGG DONATION PROGRAM. J. Hernandez, V. Sanabria, V. Pen˜a, E. Chinea, R. Bennett, A. Palumbo. Centro de Asistencia a La Reproduccio´n Humana de Canarias, La Laguna, Tenerife, Spain; Westchester Reproductive Medicine, Yorktown Heights, NY. OBJECTIVE: The optimal duration of estrogen replacement for endometrial preparation in donor egg recipients is controversial. The aim of the present study is to determine whether the duration of estrogen treatment influences implantation and pregnancy rates in donor egg recipients. DESIGN: Retrospective database analysis. MATERIALS AND METHODS: Between January 2002 and March 2006, 148 egg donation cycles were performed in 112 patients between 29 and 54 years old. Ovulation induction in egg donors was carried out using either a downregulation or an antagonist protocol, with or without birth control pill pre-treatment. Recipients received either oral estradiol valerate or transdermal estradiol for a variable number of days depending on donor availability. Vaginal progesterone suppositories were started on the day of egg retrieval. Ultrasound guided embryo transfer was performed on day 3 in the great majority of cases (n⫽120), more rarely on day 2 (n⫽13) or 5 (n⫽15). The mean number of embryos transferred was 2.1, with 2 embryos transferred in most cases, 1 embryo in 13 cases and 3 embryos in 29 cases. Patients were divided into 2 groups based on duration of treatment: ⱕ 19 (range 9 to 19) and ⱖ 20 days (range 20 to 69). Differences were analyzed using the student t test and the X2 test. RESULTS: Overall, the clinical pregnancy rate (PR) per cycle was 56.1% the ongoing (⬎20 wks) PR per cycle was 40.5%. Results in the 2 groups are shown in the table below.
CONCLUSION: Our data show that duration of estrogen treatment does not affect implantation or pregnancy rates, allowing a great flexibility in an egg donation program. Increasing the number of patients, will permit the analysis of shorter time intervals, to confirm the present findings. Supported by: None.
P-93 THE INVOCELL, A NEW MEDICAL DEVICE FOR INTRA VAGINAL FERTILIZATION AND CULTURE. L. Bonaventura, P. Ahlering, R. Morris, J. Mouchel, M. Scheiber, J. Batzofin. Bonaventura Reproductive Medicine, Carmel, IN; SIRM St. Louis, Creve Coeur, MO; IVF1, Chicago, IL; Unite D’Aide Medicale a la Procreation Clinique du Tertre Rouge, Le Mans, France; Institute for Reproductive Health, Cincinnati, OH; SIRMNY, New York, NY.
S164
Abstracts
OBJECTIVE: The INVOcell is a device designed to achieve fertilization and early embryo development by incubating eggs, sperm and resulting embryos in the vagina. This clinical study was performed to evaluate the efficacy and safety of the INVOcell. DESIGN: Multicenter, non randomized, non comparative clinical trial. MATERIALS AND METHODS: Approximately 75 women younger than 38 years old will be treated at 6 IVF centers. To date 60 women have been enrolled. Severe endometriosis, egg donors and men with severe male factor necessitating ICSI were excluded. Controlled ovarian hyperstimulation was achieved using standard protocols. Egg retrieval was performed under IV sedation. To evaluate fertilization and embryo development in the INVOcell, no less than 4 eggs and no more than 10 eggs were placed with sperm in the inner part of the device with culture medium. In some patients excess eggs were inseminated using traditional IVF or ICSI techniques. The INVOcell inner chamber was inserted into an outer chamber and the completely assembled INVOcell device was placed in the vagina with a vented diaphragm to effect retention. The INVOcell remained in the vagina for 3 days. After 3 days the diaphragm and INVOcell were removed. The diaphragm was discarded and the INVOcell device was cleaned. The inner part of the device was then placed upright for 15 minutes in an incubator at 37 °C. After 15 minutes the embryos were collected from the microchamber at the base of the INVOcell and observed to determine their stage of development and quality. At this point 1 to 3 embryos were transferred into the uterus. Study endpoints include fertilization, embryo development and pregnancy rates. RESULTS: To date the first 29 procedures have been completed, resulting in 9 pregnancies (31%, ITT). The observed fertilization rate was 48% and the lead embryos were between 6 and 14 cells. Treatment of an additional 50 patients will be completed within the next few weeks and full clinical results, as well as a study on patient acceptance, will be available at the time of presentation. CONCLUSION: Fertilization and early embryo development were effectively achieved intra vaginally within the INVOcell device and several pregnancies are ongoing. This device reduces the need for complex laboratory equipment and provides multiple options for the physician and the IVF patient. Supported by: Medelle Corporation, Woburn, MA.
P-94 THE EFFECT OF BODY MASS INDEX ON IVF OUTCOME. J. P. Stassart, G. D. Ball. RMIA, Woodbury, MN. OBJECTIVE: The objective of this study was to evaluate the effect of Body Mass Index (BMI) on In Vitro Fertilization (IVF) outcomes. DESIGN: This was a retrospective analysis of patients undergoing routine IVF. Patients were grouped into 5 categories based on BMI: ⬍21 (group 1), 21-25 (group 2), 26-30 (group 3), 30-35 (group 4), and ⬎36 (group 5). None of the patients were diagnosed as having polycystic ovarian stimulation syndrome. All patients were less than 36 years of age at stimulation start. To control for possible confounding of embryo quality at transfer and BMI grouping, sub-analyses were performed that included only patients that received two “top quality” embryos at transfer. MATERIALS AND METHODS: All patients underwent ovarian stimulation with injectible gonadotropins and received hCG to induce final follicle maturation. A transvaginal oocyte retrieval was performed 36 hr post hCG injection. Fertilization was achieved either by insemination or ICSI and embryo transfer was performed on days 3, 4 or 5 post oocyte retrieval. At the time of transfer, Day 3 embryos were evaluated and assigned a quality score based on morphological characteristics (number of cells, blastomere multinucleation, degree of fragmentation, and blastomere symetry). Day 4 embryos were scored based on degree of compaction and symetry of compaction. Day 5 embryos were scored based degree of blastocoel formation, integrity of the inner cell mass and integrity of the trophoblast. Clinical pregnancy was defined as an intrauterine gestation sac with documentation of fetal heart beat. RESULTS: When all patients were included in the analysis, the clinical pregnancy rates for groups 1-5, respectively, were 47.1% (n⫽34), 54.8% (n⫽186), 48.9% (n⫽94), 40.4% (n⫽47), and 0% (n⫽9). The R2 value for the calculated linear regression was 0.61 (Figure 1). When inclusion criteria were limited to only patients that received two embryos graded as “top quality”, pregancy rates for groups 1-5, respectively, were 63.6% (n⫽11), 67.9% (n⫽53), 60% (n⫽25), 56.3% (n⫽16), and 0% (n⫽2). The R2 value for the calculated linear regression was 0.61 (Figure 2).
Vol. 86, Suppl 2, September 2006
P-96 COMPARISON OF THREE DIFFERENT OVARIAN STIMULATION PROTOCOLS FOR INTRAUTERINE INSEMINATION. G. K. Mansour, A. Agarwal, R. Mahfouz, J. M. Goldberg, R. K. Sharma, T. Falcone. Cleveland Clinic, Cleveland, OH.
CONCLUSION: Increasing BMI values appear to have a negative impact on pregnancy outcome for IVF. Supported by: None.
OBJECTIVE: Intrauterine insemination (IUI) is usually offered to infertile couples as an easy and inexpensive method especially if the female partner has patent and well developed fallopian tubes. The aim of our study was to assess the pregnancy rate, incidence of hyperstimulation syndrome and multiple pregnancies amongst patients treated with three different ovarian stimulation protocols used for intrauterine insemination. DESIGN: A retrospective study. MATERIALS AND METHODS: We reviewed the results of 1881 cycles of IUI from 677 patients treated at the Cleveland Clinic during 2003 - 2005. Three protocols were used for ovarian stimulation, Group I (n⫽129 patients, 267 cycles) were treated with Clomiphine citrate at a dose of 100 mg/day from day 3 till day 7 of the cycle; group II (n⫽353 patients, 828 cycles) were given highly purified FSH with different doses till reaching the proper follicular size (16-18 mm). Ovulation was triggered with 10,000 IU of human chorionic gonadotropin, and IUI was carried out 36 hours later. Patients in group III (n⫽195 patients, 786 cycles) were not given any medication for ovarian stimulation and considered as natural stimulation protocol. Luteal phase was not supported by exogenous progesterone. Statistical analysis was performed using Chi square, F-Fischer ANOVA and Student’s T-test. Multiple logistic regression analysis was performed to control for age, type and duration of infertility. RESULTS: The mean age was 31.6 ⫾5.4 years; the mean duration of infertility 3.06⫾1.8 years. All treatment groups were comparable in demographic and infertility characteristics. There were significant differences in pregnancy rates per cycle as well as the incidence of hyperstimulation and incidence of multiple pregnancy rate among the three groups (Table 1). Patients under 30 years old had a pregnancy rate per cycle of 26% compared to 22% in women between 30 and 35 years old, and 12% in women over 35 years old and 5.3% in women over 40 years old. In all the cycles, pregnancy rate was significantly higher in patients under 30 years of age (p⬍0.001).
P-95 EFFECT OF BODY MASS INDEX (BMI) AND/OR WEIGHT DISTRIBUTION ON IVF OUTCOME. D. E. Woodford, M. P. Grossman, L. T. Ku, H. C. Bohler, S. T. Nakajima. Univ of Louisville, Louisville, KY. OBJECTIVE: Determine whether BMI and/or weight distribution has an effect on IVF outcome DESIGN: Historical Cohort. MATERIALS AND METHODS: Women undergoing their first-attempt at controlled ovarian hyperstimulation for in vitro fertilization using a long GnRH-agonist stimulation protocol from 1/1/03 - 12/31/05. On day of oocyte retrieval weight, height, waist and hip circumferences were obtained. BMI and waist to hip ratio (WHR) were calculated. RESULTS: 205 women were analyzed. The overall clinical pregnancy rate for this group was 53%. BMI (kg/m2) ranged from 18.2 to 50.5 with mean (⫾SD) of 26.5 (⫾6.1). WHR range from 0.59 to 1.00 with mean (⫾SD) of 0.83 (⫾0.06). Neither parameter was associated with pregnancy outcome. Different subgroups of BMI (kg/m2) (normal:19-24.9, overweight ⫽25-29.9, obese 30-34.9, morbidly obese ⬎35) were analyzed and no differences in pregnancy rates were found. In a subgroup of women with only the diagnosis of ovulation disorder (n⫽21), the range for BMI (kg/m2) and WHR was 19.8-50.5 kg/m2 and 0.76-1.00, respectiviely. The mean (⫾SD) for BMI (kg/m2) and WHR were 29.5 kg/m2 (⫾ 8.0) and 0.86 (⫾ 0.07), respectively. The clinical pregnancy rate for this subgroup was 80%. There was no significant difference in BMI and/or WHR between women who achieved pregnancy and those who did not. CONCLUSION: 1)Although prior studies have suggested that obsese women have decreased fertility, there was no effect of BMI and/or weight distribution on IVF outcome in our population, 2) When ovulatory disorders are corrected, women had a higher pregnancy rate than the general population over a wide range of BMI and weight distributions. Supported by: The Woodson Foundation.
FERTILITY & STERILITY威
CONCLUSION: Although FSH increases the pregnancy rate per cycle in patients undergoing IUI, however, it also results in a significant increase in the rate of multiple pregnancies as well as hyperstimulation syndrome. The woman’s age plays an important role in predicting good IUI outcome regardless of the ovarian stimulation protocol used. Supported by: None.
P-97 FETAL REDUCTION TO SINGLETON: IS IT JUSTIFIED FOR ART MULTIFETAL PREGNANCIES? K. Ozgur, M. Isikoglu, M. Berkkanoglu. Antalya IVF, Antalya, Turkey. OBJECTIVE: Twin gestations have relatively increased rates of fetal and maternal complications and a twin pregnancy being regarded as an adverse outcome. (Land and Evers, 2003, report of an ESHRE consensus meeting). Although currently the only preventive measure for twin pregnancy is single embryo transfer, worldwide it has not been widely applied in IVF practice yet. Another measure to prevent twin pregnancies is to reduce multifetal pregnancies to singleton when it occurs. Therefore our center has offered multifetal pregnancies an option to reduce to singleton since 2004 and was accepted in a group of 43 patients. This study is aimed to assess the safety of early transvaginal multifetal pregnancy reduction (MPR) to singleton in multifetal ICSI pregnancies. DESIGN: Retrospective study.
S165