Embryonal reduction using transvaginal saline injection in a sextuplet pregnancy after ovulation induction with human...

A sextuplet pregnancy occurred in a first treatment cycle of ovulation induction with human menopausal gonadotropins. The serum 17-beta-estradiol concentration was 1245 pg/ml on the day of human chorionic gonadotropin administration. Embryonal reduction of four fetuses was carried out at nine weeks gestation using a transvaginal ultrasound-guided approach. Under general anesthesia, a 16-gauge in vitro fertilization needle was introduced through the posterior fornix and uterine wall, into the nearest gestational sac. The embryo was penetrated and 0.9% saline solution was injected until disintegration was noted, and confirmed by a lack of pulse for more than two minutes. The same procedure was applied to the three embryos in closest proximity to the needle. The patient delivered healthy twins in the 34th week of gestation after having had pre-term contractions for two weeks.