Multiple pregnancy, caused by the practice of transferring more than one embryo into the uterus, is the commonest treatment-related adverse outcome of in vitro fertilisation (IVF). Although largely preventable by adopting a policy of elective single embryo transfer, multiple pregnancy rates following IVF remain high.
The alarming rise in multiple pregnancies resulting from the use of assisted reproductive technologies (ARTs) has led to many publications highlighting the significant maternal, fetal and neonatal risks associated with these pregnancies. Maternal complications include increased risk of pregnancy-induced hypertension, gestational diabetes, peripartum haemorrhage, operative delivery, postpartum depression, and heightened symptoms of anxiety and parenting stress. Multiple pregnancy is also associated with a six-fold increase in the risk of preterm birth, which is a leading cause of infant mortality and long-term mental and physical disabilities, including cerebral palsy, learning difficulties and chronic lung disease. Higher order multiple pregnancies resulting from cross-border reproductive care or ‘fertility tourism’ are also contributing to the challenges facing NHS maternity and neonatal services.
This paper describes current knowledge and progress made since the publication of the previous edition to reduce multiple pregnancies following ART in the UK, with reference to more recent data showing a downward trend.
Declaration of interests (guideline developers)
Mr T El-Toukhy MRCOG, London: None declared.
Professor S Bhattacharya FRCOG, Aberdeen: None declared.
Mr VA Akande MRCOG, Bristol: None declared.