Roest J, van Heusden A M, Verhoeff A, Mous H V, Zeilmaker G H
Department of Obstetrics and Gynaecology, Zuiderziekenhuis, Rotterdam, The Netherlands.
Fertil Steril. 1997 Feb;67(2):290-5. doi: 10.1016/S0015-0282(97)81913-9.
To investigate whether the incidence and obstetric outcome of triplet pregnancies after IVF treatment justify strict limitation of the number of embryos to be replaced to two.
Retrospective analysis.
A transport IVF program.
PATIENT(S): All patients who had more than one embryo replaced.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Obstetric outcome, pregnancy.
RESULT(S): High-order pregnancies occurred in 24 cases (23 triplets and 1 quadruplet). Three patients opted for selective embryo reduction (12.5%). Three triplet pregnancies spontaneously reduced to twins. Comparison of 18 triplets, reaching at least 20 weeks' gestation, with 54 twin pregnancies shows a higher perinatal mortality in the triplet group, causing 6 out of 18 patients to be confronted with at least one perinatal death. Triplets were born at a lower gestational age, had a lower birth weight, and a higher hospital admission rate of longer duration. Replacement of two, three, or four embryos did not lead to differences in pregnancy rates in the population studied. When a pregnancy occurred after replacement of three embryos, the risk of having a triplet pregnancy was 7.5%.
CONCLUSION(S): The obstetric outcome of triplet pregnancies in our population indicates that triplet pregnancies after IVF treatment have to be prevented. Selective embryo reduction is acceptable for few patients only and can therefore not be seen as a solution. Replacement of three embryos results in triplet pregnancy in an unacceptably high percentage. Replacement of two embryos only gives acceptable IVF results and is the method chosen in the IVF program in Rotterdam to prevent triplet pregnancies.
探讨体外受精（IVF）治疗后三胎妊娠的发生率及产科结局是否足以证明将移植胚胎数量严格限制为两个是合理的。
回顾性分析。
一个转运IVF项目。
所有移植了一个以上胚胎的患者。
无。
产科结局、妊娠情况。
发生了24例多胎妊娠（23例三胎妊娠和1例四胎妊娠）。3例患者选择了选择性减胎术（12.5%）。3例三胎妊娠自然减为双胎妊娠。将18例妊娠至少达到20周的三胎妊娠与54例双胎妊娠进行比较，结果显示三胎妊娠组围产儿死亡率更高，18例患者中有6例至少经历了一次围产儿死亡。三胎妊娠的孕周较低，出生体重较低，住院时间较长，住院率较高。移植两个、三个或四个胚胎在研究人群中并未导致妊娠率的差异。当移植三个胚胎后发生妊娠时，三胎妊娠的风险为7.5%。
我们人群中三胎妊娠的产科结局表明，IVF治疗后的三胎妊娠必须预防。选择性减胎术仅对少数患者可接受，因此不能视为一种解决方案。移植三个胚胎导致三胎妊娠的比例高得令人无法接受。仅移植两个胚胎可获得可接受的IVF结果，并且是鹿特丹IVF项目中为预防三胎妊娠而选择的方法。
