The natural history of multiple pregnancies after assisted reproduction: is spontaneous fetal demise a clinically significant phenomenon?
OBJECTIVE
To determine the rate of spontaneous fetal demise after heartbeats are demonstrated in multiple pregnancies conceived after IVF-ET.


METHODS
Retrospective case series.


METHODS
University-based IVF-ET program.


METHODS
Eighty-one patients in whom initial transvaginal ultrasound (US) study, performed at 5 to 6 weeks of gestation, identified more than one gestational sac. Total number of sacs was 191.


METHODS
Patients were followed by serial US examinations.


METHODS
Outcome of pregnancies.


RESULTS
Twenty-four empty gestational sacs were identified in 21 patients, of whom 15 delivered, 2 miscarried, and 4 are currently ongoing beyond first trimester. Of the 167 initially viable embryos, 9 (5%) underwent spontaneous fetal demise. In 5 of these 9 pregnancies, initial US identified significant interfetal size variation.


CONCLUSIONS
The rate of spontaneous fetal demise for a specific embryo in multiple gestation, after fetal heartbeats have been identified in early pregnancy, is 5%. This rate is similar to that seen in spontaneous conceptions. The chance of future fetal demise increases if first trimester interfetal size variation is significant.
Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel.
S
S
Kol
J
J
Levron
N
N
Lewit
A
A
Drugan
J
J
Itskovitz-Eldor
D000022:Abortion, Spontaneous / Q000000981:diagnostic imaging / Q000453:epidemiology*; D000328:Adult; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005323:Fetal Monitoring; D006801:Humans; D011247:Pregnancy; D011272:Pregnancy, Multiple; D014463:Ultrasonography