Multifetal Pregnancy Reduction - Turkishdoc IVF Center

Multifetal Pregnancy Reduction

The prevalence of assisted reproductive technologies (ART) has contributed significantly to the increase in multifetal pregnancies. In order to avoid this to happen, all steps in the fertility process, such as the transferred embryo number, the effect of fertility drugs on ovulation, etc., are carefully monitored. However, when multiple pregnancies occur despite the precautions taken, all risks should be examined and options for continuation of pregnancy or fetal reduction should be evaluated.

What is Multifetal Pregnancy Reduction?

Multifetal pregnancy reduction (MFPR), also known as fetal or selective reduction, is a medical procedure performed to reduce one or more fetuses in a pregnancy. This procedure is usually done in the first trimester of pregnancy to increase the chances of a healthy pregnancy.

Why is Multifetal Pregnancy Reduction done?

More than one fetus can decrease the chances of a healthy pregnancy or may cause preterm birth. The higher the number of fetuses, the higher the risk a mother carries. Therefore, a fetal reduction procedure may help maintain a healthy pregnancy and minimize the risks and complications such as miscarriage, early delivery, dissabilities that may occur during the pregnancy.

What are the risks associated with Multifetal Pregnancy?

The risks that a mother faces during a pregnancy with more than one fetus are as follows:
Preeclampsia:
Preeclampsia is a condition that can happen during a multiple pregnancy. Symptoms of preeclampsia include high blood pressure, protein in their urine, swelling, headaches and blurred vision. According to a AHAJournal article, women having more than one fetus are 3 to 4 times more likely to experience preeclampsia, due to greater strain on the cardiovascular system, which is demonstrated by an increase in cardiac output and decrease in total vascular resistance.
Gestational diabetes:
Gestational diabetes is a form of diabetes that can develop in non-diabetic pregnant women, and it happens because the body is unable to produce sufficient insulin during pregnancy. Recent studies confirm that multifetal pregnancy has been associated with the risk of developing gestational diabetes.
Preterm birth:
Preterm birth is another risk associated with multifetal pregnancy. It is known that multiple pregnancy increases the probability of premature birth, as the increase in the number of fetuses causes the uterus to expand more.
Miscarriage and stillbirth:
The greater the number of embryos in your uterus, the higher your risk of miscarriage or stillbirth. To avoid this risk, MFPR may be advised to you by your doctor.
Increased maternal depression and anxiety:
A study from 2009 that was published in the journal of Pediatrics found that moms who are giving birth to multiple babies were 43% more likely to have postpartum depression than moms who only had one baby.

Risk factors for Multifetal Pregnancy on fetuses
There are also several risk factors affecting the fetuses of multifetal pregnancy. Those are:
* Low birth weight: Babies of multiple births weigh less than singletons. This is because the already limited expansion capacity of the uterus undergoes further expansion than normal, thus restricting the further growth of the babies.

* Cerebral palsy: According to the CDC, children of multiple births have a higher risk of developing cerebral palsy, especially in the event that one of a baby’s siblings passes away before or soon after the birth.

* Chronic lung disease: Chronic lung disease of prematurity is the indirect effect of multiple birth. The babies of multiple births are generally subjected to preterm birth. Preterm birth is associated with the incomplete development of several organs when baby is born. However, current techniques have increased the survival rate of these premature babies with medical conditions, such as chronic lung disease.

* Learning difficulties: Premature babies can also show increased risk for learning difficulties because they are born without completing their development.

How is MFPR performed?

Fetal reduction procedures are ideally performed between 10th to 12th weeks of pregnancy. It is commonly done transabdominally because transvaginal or transcervical approaches have been found to be associated with higher risks of miscarriage.

Before performing MFPR, an examination should be performed to determine the position and chorionicity of the fetuses. The decision of which fetus or fetuses to abort is made by considering current screening results, the presence of early intrauterine growth restriction, or other evidence of a major fetal anomaly. If all prenatal diagnostic tests are normal, the most accessible fetuses are targeted for reduction. Ultrasound is used as a guide during the procedure. The doctor injects a drug containing potassium chloride into the selected fetus or fetuses with a needle inserted through the abdomen if transabdominal technique is applied. Thus, the embryo or fetus loses its vitality and is absorbed by the mother’s body. The remaining fetus is monitored for a period of time to confirm the multifetal pregnancy reduction is successfully completed.

Fetal reduction should be distinguished from selective reduction, in which it is reduced because of a structural or genetic abnormality, regardless of the position of the fetus.

What happens after MFPR?

You may experience slight bruising and pain at the needle insertion site. Spotting and bleeding is considered normal. Your doctor may prescribe medications for your pain. You should follow your doctor’s instructions for your recovery period. There are generally no restrictions for daily activities. However, resting for 3 days is recommended to minimize the possibility of infection.

If there is a high fever, severe vaginal bleeding or convulsions, you should immediately consult your doctor.

What are the risks of MFPR?

The risks of the procedure are similar to the complications that may occur after the amniocentesis method. These include;

  • leakage of amniotic fluid from the sac of a living fetus,
  • placental abruption,
  • infection (chorioamnionitis), and
  • miscarriage.

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2023-05-22
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Frequently Asked Questions

What is IVF?

IVF treatment (in vitro fertilization) was first successfully applied in England in 1978.

Factors that cause infertility (infertility) in women;

  • Ticking of the egg ducts (fallopian tubes)
  • Uterine (uterine) and congenital abnormalities
  • Benign uterine urlar (fibroids)
  • Intrauterine adhesions (uterine sineuses)

Factors that cause infertility (infertility) in men;

  • Low sperm count
  • Slowness in sperm movement
  • Disfigurement or inability to see sperm cells

According to statistics, more than 4 million children were born by IVF method all over the world.

IVF treatment has been a great gateway to hope for couples who cannot have children by natural means thanks to technology, improved laboratory facilities and research that have advanced in the last 30 years.

What are the factors affecting the success rate of IVF?

In vitro fertilization is one of the factors affecting the rate of success, especially:

  • The age of the patient
  • Type of infertility diagnosis
  • Duration of infertility
  • Hospital / doctor experience / expertise
  • Number of embryos transferred
  • Type of IVF performed: stimulated or natural cycle IVF

For women younger than 34, most will achieve pregnancy within 1 to 3 treatment cycles; indeed, many are successful on their first attempt.

Success rates for women over 35 tend to decrease as aging affects the quality of these women’s eggs.

For a detailed discussion about IVF success rates, couples should visit the website for the clinic where they are considering treatment. They should also discuss specific fertility possibilities with reproductive endocrinologists.

IVF pregnancy rates vary by clinic, so patients should carefully examine their chances of success in the treatment of specific clinical practice.

How is IVF performed?

At the beginning of the IVF process, the ovaries are stimulated with special drugs so that a large number of egg cells can be obtained from the woman.

This process varies from patient to patient.

Drugs are used for 15-20 days. After the ovaries become suitable with ultrasound and hormones with a blood test, egg collection is performed. Eggs are collected through the vaginal route with the help of ultrasound.

On the same day, sperm is taken from the man and a normal IVF or microinjection process is performed in the laboratory for the process of fertilization.

The fertilized egg, which becomes an Embryo, is transferred to the woman after two to five days.

What is infertility?

Infertility refers to the inability to conceive after having regular unprotected sex. Infertility refers to an individual’s biological incapacity to contribute to conception, or to a woman who is unable to carry her pregnancy to full maturity.

Infertility in many countries means a couple who cannot conceive after 12 months of regular sexual intercourse without using contraception.

Research shows that most cases of infertility are caused by more than half of women, with the rest due to sperm disorders or unidentified factors caused by men.

Most cases of apparent infertility are treatable. Infertility can have a single cause in one of the partners, or it can be the result of a combination of factors.

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For more information and support on IVF and infertility, consider reaching out to Turkishdoc and support organizations to access the guidance and resources you need on your journey.

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