Hum Reprod. 2000 Aug;15(8):1856-64.
Multiple gestation pregnancy rates are high in assisted reproductive treatment cycles because of the perceived need to stimulate excess follicles and transfer excess embryos in order to achieve reasonable pregnancy rates. Perinatal mortality rates are, however, 4-fold higher for twins and 6-fold higher for triplets than for singletons. Since the goal of infertility therapy is a healthy child, and multiple gestation puts that goal at risk, multiple pregnancy must be regarded as a serious complication of assisted reproductive treatment cycles. The 1999 ESHRE Capri Workshop addressed the psychological, medical, social and financial implications of multiple pregnancy and discussed how it might be prevented. Multiple gestations are high risk pregnancies which may be complicated by prematurity, low birthweight, pre-eclampsia, anaemia, postpartum haemorrhage, intrauterine growth restriction, neonatal morbidity and high neonatal and infant mortality. Multiple gestation children may suffer long-term consequences of perinatal complications, including cerebral palsy and learning disabilities. Even when the babies are healthy they must share their parents' attention and may experience slow language development and behavioural problems. Current data indicate that the average hospital cost per multiple gestation delivery is greater than the average cost of in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles. Prevention is the most important means of decreasing multiple gestation rates. Multiple gestation rates in ovulation induction and superovulation cycles can be reduced by using lower dosage gonadotrophin regimens. If there are more than three mature follicles, the cycle should be converted to an IVF cycle, or it should be cancelled and intercourse should be avoided. In IVF cycles two embryos can be transferred without reducing birth rates in most circumstances. Embryo reduction involves extremely difficult decisions for infertile couples and should be used only as a last resort. Assisted reproductive treatment centres and registries should express cycle results as the proportion of singleton live births; twin and triplet rates should be reported separately as complications of the procedures. Reducing the multiple gestation pregnancy rate should be a high priority for assisted reproductive treatment programmes, despite the pressure from some patients to transfer more embryos in order to improve success. If nothing is done, public concern may lead to legislation in many countries, a step that would be unnecessary if assisted reproductive treatment programmes and registries took suitable steps to reduce multiple pregnancy rates.
在辅助生殖治疗周期中，多胎妊娠率较高，这是因为人们认为有必要刺激过多卵泡并移植过多胚胎，以获得合理的妊娠率。然而，双胞胎的围产期死亡率是单胎的4倍，三胞胎的围产期死亡率是单胎的6倍。由于不孕治疗的目标是生出健康的孩子，而多胎妊娠会使这一目标面临风险，因此多胎妊娠必须被视为辅助生殖治疗周期的一种严重并发症。1999年ESHRE卡普里研讨会探讨了多胎妊娠的心理、医学、社会和经济影响，并讨论了如何预防多胎妊娠。多胎妊娠是高危妊娠，可能并发早产、低出生体重、先兆子痫、贫血、产后出血、宫内生长受限、新生儿发病率以及高新生儿和婴儿死亡率。多胎妊娠的儿童可能会遭受围产期并发症的长期后果，包括脑瘫和学习障碍。即使婴儿健康，他们也必须分享父母的关注，可能会出现语言发育迟缓及行为问题。目前的数据表明，每次多胎妊娠分娩的平均住院费用高于体外受精（IVF）和卵胞浆内单精子注射（ICSI）周期的平均费用。预防是降低多胎妊娠率的最重要手段。通过使用较低剂量的促性腺激素方案，可以降低诱导排卵和超排卵周期中的多胎妊娠率。如果有三个以上成熟卵泡，该周期应转换为IVF周期，或者应取消该周期并避免性交。在IVF周期中，在大多数情况下，移植两个胚胎不会降低出生率。减胎术对不孕夫妇来说涉及极其艰难的决定，应仅作为最后手段使用。辅助生殖治疗中心和登记处应将周期结果表示为单胎活产的比例；双胞胎和三胞胎率应作为程序并发症单独报告。尽管一些患者为了提高成功率而施加压力要求移植更多胚胎，但降低多胎妊娠率应是辅助生殖治疗计划的高度优先事项。如果不采取任何措施，公众的关注可能会导致许多国家立法，而如果辅助生殖治疗计划和登记处采取适当措施降低多胎妊娠率，这一步骤将是不必要的。
