Early transvaginal embryo aspiration: a safer method for selective reduction in high order multiple gestations

Area of Science:

• Reproductive Medicine
• Maternal-Fetal Medicine
• Perinatology

Background:

• Assisted reproduction technologies (ART) and ovulation induction frequently result in high-order multiple gestations.
• These pregnancies carry increased risks of perinatal and maternal morbidity and mortality.
• Selective fetal reduction is a therapeutic option, typically performed after the ninth week of gestation.

Purpose of the Study:

• To evaluate the safety and efficacy of early transvaginal selective embryo aspiration for multiple pregnancy reduction.
• To compare pregnancy loss rates with historical data from later-gestation procedures.

Main Methods:

• A retrospective review of 90 women undergoing early transvaginal selective embryo aspiration (mean 7.5 weeks gestation).
• Embryo numbers were assessed before and after reduction.
• Pregnancy outcomes, including loss, complications, and gestational age at delivery, were analyzed.

Main Results:

• The mean number of viable embryos decreased from 3.5 to 2.1 post-procedure.
• Overall pregnancy loss rate was 6.7% (6/90 pregnancies).
• In women with >=4 initial embryos, the pregnancy loss rate was significantly lower (2.6%) compared to historical data (15.3%).
• Premature delivery occurred in 4.4% of pregnancies, with a mean gestational age at delivery of 35.7 weeks.

Conclusions:

• Early transvaginal embryo aspiration is a simple and relatively safe method for reducing multiple pregnancies.
• The overall pregnancy loss rate is comparable to later-gestation procedures.
• Early embryo aspiration demonstrates a significantly lower pregnancy loss rate when the initial number of embryos is four or greater.