title: Survival rates during the first trimester of multiple gestations achieved by ICSI: a report of 1448 consecutive multiples.
abstract: BACKGROUND
  The purpose of this study was to determine the rate of spontaneous gestational sac loss during the first trimester in women achieving multiple pregnancies by ICSI.
  
  
  METHODS
  A retrospective analysis was performed of 1448 consecutive multiple pregnancies conceived by ICSI.
  
  
  RESULTS
  Of the cohort of 1448 pregnancies, twin gestations constituted 59.6% (864), triplets 30.2% (438) and quadruplets 10.0% (146). During the first trimester, 69 (4.7%) patients miscarried, while 179 (12.3%) continued their pregnancies and had fewer gestational sacs at the end of the first trimester than at the beginning. The overall loss rate of any gestational sac during the first trimester in these multiple pregnancies was 10.1%. There was a significant difference in the frequency of spontaneous reduction to twin or singleton pregnancies in the first trimester between women carrying triplets (11.7%) and those carrying quadruplets (3.5%) [P = 0.004; odds ratio (OR) 3.5; 95% confidence interval (CI) 1.3-9.1]. The frequency of gestational sac loss was significantly greater among women >35 years old (20.9%) than in women less than 35 years old (15.9%) (P = 0.03; OR 1.4; 95% CI 1.0-1.9).
  
  
  CONCLUSIONS
  In multiple pregnancies there is a significant risk of spontaneous loss of any embryo during the first trimester. These findings should be considered prior to any decision about selective embryo reduction.
authors.affiliation: Bahceci Women Health Care Center and German Hospital at Istanbul, Turkey.
authors.forename: Ulun
authors.initials: U
authors.lastname: Ulug
authors.forename: Esra Aksoy
authors.initials: EA
authors.lastname: Jozwiak
authors.forename: Ali
authors.initials: A
authors.lastname: Mesut
authors.forename: Mustafa Murat
authors.initials: MM
authors.lastname: Berksoy
authors.forename: Mustafa
authors.initials: M
authors.lastname: Bahceci
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000328:Adult; D000367:Age Factors; D005260:Female; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D018566:Pregnancy, High-Risk; D011272:Pregnancy, Multiple; D011783:Quadruplets; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D014310:Triplets