No abstract available.
Female ; Pregnancy ; Pregnancy, Multiple*

No abstract available.
Female ; Perinatal Mortality* ; Pregnancy ; Pregnancy, Multiple*

Aims: To study the validity of a scoring system in evaluating embryo quality and predicting pregnancy potential. The scoring system was formulated using morphologic parameters and cleavage rates. Embryos were scored between 0 and 10 according to morphologic criteria and cleavage rate. Materials and METHODS: The pregnancy results of 2,371 fresh embryos scored by this criteria and transferred between January 1991 and September 1992 in the Monash IVF Program, Melbourne, Australia were analysed for this study. RESULTS: Analysis of 2,371 fresh embryos scores from 926 consecutive transfers showed that intrauterine and multiple pregnancy rate increased significantly along with increased total score per transfer(p < 0.05). Pregnancy rate also increased from 10.7% to 21.6% as the number of embryos with a score of 7 or more(good embryo) increased from 0 to 3(p < 0.05). The well-known relationship between the number of embryos transferred and pregnancy rate was also found but this correlation could not seen when all of added embryos were scored less than 7. When all the embryos in a given transfer were scored less than 4(poor embryo), the pregnancy rate was near zero regardless of the number of embryos transferred. Conclusion: This study indicated that an embryo scoring system based on morphologic and cleavage rate criteria could be useful in selecting good quality embryos and predicting the pregnancy rate in an IVF/ET program.
Australia ; Embryonic Structures* ; Female ; Pregnancy Rate ; Pregnancy* ; Pregnancy, Multiple

OBJECTIVE: Evaluation of early cleaving time to 2-cell stage has been proposed for the selection of embryos with high implantation potential. In order to provide criteria for the selection of early cleaving 2-cell embryo, a prospective study was performed. METHODS: Embryos that had cleaved early at 25 hours and 27 hours postinsemination were designated as EC (early cleavage)-1 and EC-2, respectively, while others were designated as NEC (non-early cleavage). Statistical analysis was performed using the unpaired student t-test and chi-square test. P<0.05 was considered statistically significan RESULTS: At least one early cleavage embryo was observed in 98 (51.5%) for the EC-1 and 44 (23.2%) for the EC-2 of the 190 cycles assessed. Clinical pregnancy rates were significantly higher in the EC-1 group (58.2%) compared to the EC-2 group (31.8%) or the NEC group (22.9%) (P<0.05). Clinical pregnancy rates and implantation rate were increased if at least one EC-1 embryo was produced, and the increased pregnancy outcome was related positively with the number of EC-1 embryo. When the number of EC-1 embryo transferred was 0 or 1, most pregnancies were singleton (88.0%, 87.5%, respectively). However, when the number of EC-1 embryo transferred was 2 or more, multiple pregnancy rates were increased up to around 40%. CONCLUSION: These results shows that 25 hours postinsemination is more effective than 27 hours as a critical time-point for the selection of early cleaving 2-cell embryos with high implantation potential, and that number of early cleaving embryos is an important parameter for the prediction of pregnancy outcome including the chance of multiple pregnancies.
Embryonic Structures* ; Female ; Humans ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Rate ; Pregnancy* ; Pregnancy, Multiple ; Prospective Studies

We report on two cases of diamniotic dichorionic pregnancy with delayed delivery of the second twin. Case 1 was a 29-year-old woman with a twin pregnancy at 19 weeks and 0 day presenting with a preterm rupture of the membranes (PROM) of the first twin. The patient was treated with ritodrine and systemic broad-spectrum antibiotics. Six hours after admission, the first twin was delivered stillborn without complication. At 23 weeks and 5 days, preterm labor resulted in and the second twin being delivered stillborn at a weight of 564 g. The interval between the first and second delivery was 33 days. Case 2 was a 30-year-old woman with a twin pregnancy at 15 weeks and 4 days presenting with amniotic fluid leakage. PROM was found, and she was treated with ritodrine and systemic broad-spectrum antibiotics. The next day, the first twin was delivered stillborn. At 26 weeks, due to adverse effects, ritodrine was changed to isoxsuprine and magnesium sulfate to control uterine contractions. At 33 weeks and 5 days, onset of labor was observed, and 11 hours after the cessation of treatment with isoxsuprine and magnesium sulfate, a viable female fetus was delivered by spontaneous vaginal delivery, weighing 1,806 g. The mother developed atonic bleeding of the uterus immediately after delivery.;The interval between the first and second twin deliveries was 33 days in case 1 and 127 days in case 2. The longer interval resulted in better fetal outcome, but it also may have increased the risk to the mother.
Twin Multiple Birth ; Delivery ; week ; Ritodrine ; Pregnancy

The objective of this paper was to provide some insights and developments in the physiology of the blastocyst and offer the advantages of blastocyst transfer as the optimal choice for in-vitro fertilization and embryo transfer.
Human ; Female ; Adult ; PREGNANCY ; PREGNANCY, MULTIPLE ; EMBRYO TRANSFER ; FERTILIZATION IN VITRO

OBJECTIVE: To compare the pregnancy outcomes of transvaginal multifetal pregnancy reduction (MFPR) according to the gestational period when the procedure was performed METHODS: From January l995 to February 1998, total 27 patients with multiple pregnancy were included in this study. The patients were grouped to early MFPR group (<8 weeks, n=16) and delayed MFPR group (>8 weeks, n=ll) according to the gestational age that MFPRs were performed. All MFPRs were performed by transvaginal sonography-guided fetal aspiration or mechanical trauma. The complete pregnancy loss rate before 24 weeks of gestation, spontaneous loss of embryo, procedure-related complication, gestational age at delivery, and pregnancy complication were compared between the two groups. Statistical analysis of data was performed using Students t-test and Fishers exact test as appropriate. Statistical significance was defined as p<0.05. RESULTS: There was no significant difference in the complete pregnancy loss rate between the early MFPR group (6.3%) and the delayed MFPR group (27.3%). The incidence of partial spontaneous loss of embryo in the two groups were not differed significantly (6.3% vs. 18.2%). The procedure-related complication of the delayed MFPR group (36.4%) seemed to be higher than that of the early MFPR group (6.3%), however there was no statistical difference (p=0, 07). Especially, all 3 patients in whom the MFPR was performed after 10 weeks suffered from the procedure-related complication. The mean gestational age at delivery of the two groups were not differed significantly (36.3+2.8 weeks vs. 37.0+1.3 weeks). There was also no significant difference in the mean birth weights of the two groups (2378.8+563.7 gm vs. 2427.1+436.2 gm). CONCLUSION: Although there was no statistically significant difference, the early transvaginal MFPR might be a safe and useful method without significant adverse complications compared to the delayed MFPR.
Birth Weight ; Embryonic Structures ; Female ; Gestational Age ; Humans ; Incidence ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Pregnancy Reduction, Multifetal* ; Pregnancy, Multiple

OBJECTIVE: To compare the clinical efficacy of double intrauterine insemination with single intrauterine insemination in GnRH antagonist combined ovarian hyperstimulation (Mild ovarian hyperstimulation) MATERIALS AND METHODS: From Jan. 2001 to Jul. 2004, a retrospective clinical analysis was done of a total of 295 cycles in 170 patients who underwent ovarian hyperstimulation for ART (assisted reproductive technique). Subjects were divided into three groups; only clomiphene citrate ovarian hyperstimulation (n=55, 95cycles), GnRH antagonist combined ovarian hyperstimulation (soft ovarian hyperstimulation) (n=66 99cycles), and GnRH agonist combined ovarian hyperstimulation (short protocol) (n=49, 101cycles) Each group were randomly devided into two subgroups. One group underwent single IUI and the other group underwent double IUI. RESULTS: GnRH antagonist group and GnRH agonist group had similar pregnancy rate. In GnRH antagonist Group, pregnancy rate was 36.1% in single IUI subgroup and was 36.6% in double IUI subgroup. These finding were not statistically significant. And Pregnancy rate was 20.8% in single IUI subgroup and was 19.3% in double IUI subgroup in single clomiphene citrate group, and 36.3% in single IUI subgroup and was 33.3% in double IUI subgroup in GnRH agonist group. These finding were not statistically significant, too. CONCLUSION: Pregnancy rate of GnRH antagonist was high and complication rate such as OHSS and multiple pregnancy was lower. In GnRH antagonist group, to compare with single IUI and double IUI, the result do not statistically differ. So GnRH antagonist single injection with single IUI was relatively comparable ART in infertiliry patient.
Clomiphene ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Infertility* ; Insemination* ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple ; Retrospective Studies

OBJECTIVE: To investigate the effect of the type of placenta and the portion of umbilical cord insertion on birthweight and growth discordancy in twin pregnancies. METHODS: We selected 120 twins of 146 multiple pregnancies between March, 2000 and March, 2002, and one fetus of all cases at least weighed 500 g or more and over 24 weeks of gestation. The fetuses were included that 44 twins (88 fetuses) had monochorionic placentas and the 76 twins (152 fetuses) had dichorionic placentas. The dichorionic twins were divided into two groups; one (38 twins, 76 fetuses) showed the fused type of placenta and the other (38 twins, 76 fetuses) showed the separate type of placenta. The types of umbilical cord insertion were also divided into the central portion and the peripheral portion, the peripheral portion was defined within 2 cm of margin of placenta, and included marginal and velamentous insertion of umbilical cord. Stastical analysis were performed with Student t-test and runs test. p<0.05 was defined significantly. RESULTS: 1. The central type of umbilical cord insertion in dichorionic placenta was more frequent than that of monochorionic placenta (p<0.01). 2. The dichorionic infants, regardless the number of placenta, who weighed more than monochorionic infants at birth (p<0.01). 3. Twin pairs with over 25% of growth discordancy were 16 cases (13.3%), which included 9 cases (9/76, 11.8%) of dichorionic placenta and 7 cases (7/44, 15.9%) of monochorionic placenta. The severe growth discordancy was more commonly developed in monochorionic twins than dichorionic twins (p<0.01). 4. Perinatal deaths in twin pairs with over 25% of GD were 12 cases, which included 3 cases (3/18, 16.7%) of dichorions, and 9 cases (9/14, 64.3%) of monochorions. Therefore, perinatal death was showed more commonly in monochorinic twin infants (p<0.01). CONCLUSION: The type of umbilical cord insertion affected the birthweight of dichorionic separated infants. Monochorionic placenta attributed to more severe growth discordancy and increased perinatal death rate than the dichorionic placenta. Antenatal detection of chorionicity and the portion of umbilical cord insertion may improve the perinatal outcome.
Chorion ; Female ; Fetus ; Humans ; Infant ; Mortality ; Parturition ; Placenta* ; Pregnancy ; Pregnancy, Multiple ; Pregnancy, Twin* ; Umbilical Cord*

As a result of the increased use of drugs that enhance fertility, and the advent of in vitro fertilization and embryo transfer over the last 2 decades, the incidence of multifetal pregnancies has increased exponentially. In parallel with this increase methods of care for women carrying multiple fetuses have become more complex and well developed. Importantly, it has become obvious that in the case of such pregnancies the rates of mortality and morbidity of both fetuses and mothers, particularly in cases where four or more fetuses are involved, are extremely high. Improvements in the techniques of assisted fertilization should result in fewer yatrogenic multifetal pregnancies and a commensurate decrease in related risks. Fetal reduction seems to be an acceptable method of improving maternal and fetal outcome in high order multiple pregnancies despite the many unresolved medical and ethical dilemmas.
*Ethics, Medical ; Female ; Human ; Pregnancy ; *Pregnancy Reduction, Multifetal/adverse effects/methods ; *Pregnancy, Multiple