Early versus Late Multifetal Pregnancy Reduction in Triplet Pregnancies after In Vitro Fertilization/Intracytoplasmic Sperm Injection

AbstractBackground Multifetal pregnancy reduction (MPR) has emerged as an important option to improve the obstetric outcomes in high-order multiple pregnancies (HOMPs, n ≥ 3). However, information regarding the optimal timing of MPR for triplet pregnancies conceived by in vitro fertilization (IVF) is based on limited and contradictory data. Methods A retrospective cohort study including triplet pregnancies conceived by IVF/ intracytoplasmic sperm injection (ICSI) was conducted in a reproductive center. According to the timing of MPR, participants who underwent MPR operations were divided into the early MPR group (MPR before 9 weeks) and late MPR group (MPR at 11–20 weeks). Spontaneous reduction (SR) occurred in part of the participants, therefore, the incidence of SR was calculated. The pregnancy outcomes as well as maternal and perinatal complications were compared among the groups. Result(s): The prevalence of spontaneous loss of at least one fetus was 38.3% in triplet pregnancies, of which 89.3% occurred before 12 weeks. The final sample sizes for the three groups were: early SR group (SR before 12 gestational weeks, n = 209), early MPR group (n = 131) and late MPR group (n = 107). Singletons born after early MPR had a higher mean birth weight than those in the late MPR group (3268 ± 516g vs. 2955 ± 626g, P = 0.010). Compared to late MPR, early MPR was associated with a higher risk of spontaneous fetal loss (14.5% vs. 5.6%, P = 0.020, OR:3.23) and postprocedural fetal loss (13.7% vs. 3.7%, P = 0.007, OR: 4.84). No significant difference was manifested in the pregnancy outcomes as well as maternal and perinatal complications between the early SR group and early MPR group. Conclusion Despite the comparable maternal and perinatal outcomes, early MPR increased the risks of spontaneous fetal loss and postprocedural fetal loss compared to late MPR. And the overall SR rate was 38.3%, with most of which occurred before 12 gestational weeks. Waiting for a late MPR for IVF triplet pregnancies might be a preferable choice.