Twin pregnancy, contrary to consensus, is a desirable outcome in infertility

被引:62
作者
Gleicher, Norbert [1 ,2 ,3 ]
Barad, David [1 ,2 ,4 ,5 ]
机构
[1] Ctr Human Reprod, New York, NY USA
[2] Fdn Reprod Med, New York, NY USA
[3] Yale Univ, Sch Med, Dept Obstet Gynecol & Reprod Sci, New Haven, CT USA
[4] Albert Einstein Coll Med, Dept Epidemiol & Social Med, Bronx, NY 10467 USA
[5] Albert Einstein Coll Med, Dept Obstet Gynecol & Womens Hlth, Bronx, NY 10467 USA
关键词
Twins; twin pregnancy; multiple births; in vitro fertilization; infertility; fertility treatment; adverse outcomes; SINGLE-EMBRYO-TRANSFER; IN-VITRO FERTILIZATION; ASSISTED REPRODUCTIVE TECHNOLOGIES; COST-EFFECTIVENESS ANALYSIS; ORDER MULTIPLE PREGNANCY; DANISH NATIONAL COHORT; OVARIAN STIMULATION; ECONOMIC-IMPACT; BIRTHS; GESTATIONS;
D O I
10.1016/j.fertnstert.2008.02.160
中图分类号
R71 [妇产科学];
学科分类号
100211 [妇产科学];
摘要
Objective: To determine whether the worldwide consensus that twin pregnancy after fertility treatment represents an adverse outcome to be avoided is correct. Design: Literature search via PubMed and MEDLINE, going back to 1990. Setting: Academically affiliated private fertility center. Patient(s): Mothers and offspring in singleton and twin pregnancies. Intervention(s): None. Main Outcome Measure(s): Maternal and perinatal/neonatal risks as well as cost considerations for singleton versus twin pregnancies. Result(s): Most risk assessments of twin pregnancies after fertility treatment have used spontaneous conceptions data, which reflect different treatment paradigms and outcome benefits from pregnancies after fertility treatments. In vitro fertilization (IVF) twins demonstrate approximately 40% lower outcome risks than spontaneous twin conceptions. Most risk assessments in the literature are calculated with pregnancy as the primary outcome, but in a fertility-treatment paradigm where patients want more than one child the statistically correct risk assessment should refer to born children as the primary reference. If published data are corrected accordingly to achieve statistical commonality of outcome (i.e., one child in singleton versus two children in twins), twin pregnancies no longer demonstrate a significantly increased risk profile and/or cost for mothers or individual offspring. Conclusion(s): For infertile patients who want more than one child, twin deliveries represent a favorable and cost-effective treatment outcome that should be encouraged, in contrast to the current medical consensus. (Fertil Steril (R) 2009;91:2426-31. (C) 2009 by American Society for Reproductive Medicine.)
引用
收藏
页码:2426 / 2431
页数:6
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