title: Multiple gestations/pregnancies from IVF process in a fertility center in Nigeria, 2009-2011: implementing policy towards fewer (double and single) embryo transfer.
abstract: BACKGROUND
  Infertility is a major problem in Nigeria, which has caused many couples to be burdened with physical, psychological and social issues. IVF (In-vitro fertilization) has played a major role in reducing the burden among infertile couples. However, despite the role of IVF in solving infertility in Nigeria, it is important to address the issue of rising rates of multiple births from IVF. Also to create a balance between the number of embryo transferred and easing the burden couples face from infertility.
  
  
  OBJECTIVE
  To determine the trend/rate in multiple gestations from IVF, identify possible factors responsible and proffer ways to reduce multiple gestation rates.
  
  
  METHODS
  We did a case series review from 2009-2011 of IVF cycles performed at a private clinic with an academic setting in Nigeria. Our primary outcome of interest was multiple gestations/pregnancies All patients identified with outcome of interest, were included in the study sample. We reviewed the IVF process of each patient using medical records from pre-evaluation to clinical pregnancy confirmed by ultrasound. We reported the multiple gestation trend/rate.
  
  
  RESULTS
  25 women with the mean age of 39.9 +/- 7.3 years had multiple pregnancies from 2009 to 2011. Of the 25 women, 24% of the pregnancies, occurred in 2009, 40% occurred in 2010 and 36% in 2011. In 2009, 83% of the pregnancies were twin gestations and 17% triplets. In 2010, 40% were twin gestations, while triplet, quadruplet and quintuplet gestations were 20% each. In 2011, 66% were twin gestations and 34% quadruplet gestation. The factors we identified that could have lead to an increase in multiple gestations from 2009-2010 included improvement in pre-evaluation work up, stimulation protocol, efficacy of the IVF lab and mean of 5 embryos transferred. In 2011, embryo transferred was reduced to 3-4. From 2009 to 2011, mean number of embryos transferred was 4.2 (95% CI: 3.87-4.47).
  
  
  CONCLUSIONS
  Multiple gestations and associated risk from IVF in Nigeria can be reduced by reduction in number of embryos transferred and possibly by improvement in practice process. As the IVF process becomes more efficacious, fertility centres in Nigeria will not need to transfer up to 4 embryos in order to have a positive pregnancy; and as a result they can move towards two to single embryo transfer.
authors.affiliation: Department of Reproductive Endocrinology and Fertility, Medical Art Centre, 21 Mobolaji Bank Anthony Way, Ikeja, Lagos. oluwakemio@gmail.com
authors.forename: Oluwakemi Y
authors.initials: OY
authors.lastname: Olukoya
authors.forename: Chizara C
authors.initials: CC
authors.lastname: Okeke
authors.forename: Ailoje-Ibru
authors.initials: AI
authors.lastname: Kemi
authors.forename: Rose O
authors.initials: RO
authors.lastname: Ogbeche
authors.forename: Abiola J
authors.initials: AJ
authors.lastname: Adewusi
authors.forename: Oladapo A
authors.initials: OA
authors.lastname: Ashiru
mesh_terms: D000328:Adult; D000367:Age Factors; D002985:Clinical Protocols; D004624:Embryo Transfer / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods* / Q000706:statistics & numerical data*; D006291:Health Policy; D006801:Humans; D008875:Middle Aged; D009099:Multiple Birth Offspring / Q000706:statistics & numerical data; D009549:Nigeria / Q000453:epidemiology; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*