The goal of the infertility treatment should be the birth of one healthy child. Many of the treatment options offered to infertile couples, however, are associated with high risks of multiple gestation. In addition, many couples see multiple pregnancy as a desired situation and are not aware of the risks that this generates for both parents and newborns.

Patients must understand these potential risks before starting treatment.

Complications of the fetus and the newborn with multiple gestations
• Preterm birth occurs more than 50% in twin births, 90% in triplets, and virtually in all quadruple pregnancies.
• Compared to a single gestation, it is 7 and 20 times more probable for a twin and a triple, respectively, to die during the first month of life.
• Prematurity is associated with an increased risk of respiratory distress syndrome (RDS), intracranial hemorrhage, cerebral palsy, blindness, low birth weight and increased neonatal morbidity and mortality. Respiratory distress syndrome accounts for approximately 50% of neonatal deaths associated with prematurity.
• Intrauterine growth retardation. Intrauterine death of one or more fetuses, abortions and congenital anomalies are more common in multiple pregnancies.
• Long-term disability is more than 25% more frequent in babies who weighted less than 1000 grams. (2 lbs., 3oz.)

Maternal complications associated with multiple gestation
• Preeclampsia, usually defined as pregnancy-induced hypertension, occurs three to five times more frequently. Severe preeclampsia can cause life risk for the mother and the newborn.
• Premature delivery requires more bed rest or prolonged hospitalization.
• Placental abnormalities associated with maternal hemorrhages are more frequent
• Gestational diabetes, anemia and polyhydramnios (excess amniotic fluid) occur more frequently.
• Performing a cesarean section may be needed for twin births and is always an indication for triplet births.

Other considerations
• Multiple pregnancies are most commonly associated with nausea and vomiting, anemia, fatigue, weight gain, heartburn, drowsiness, financial difficulties, depression and marital problems.
• Embryoreduction should be advised by maternal health and to improve the survival of the pregnancy. In any case, it is not clear how effective this technique is in reducing the frequency of many of the drawbacks discussed above. Couples contemplating this option should be advised.

Prevention of multiple pregnancies
• Careful monitoring during treatment with ovulation-inducing drugs.
• Limit the number of embryos to be transferred during fertilization (IVF). The transfer of multiple embryos will not improve pregnancy rates, but it will clearly increase the risk of multiple pregnancy. The Society for Assisted Reproduction Techniques (SART) and the American Society for Reproductive Medicine (ASRM) have published guidelines recommending the optimal number of embryos to be transferred, based on the patient’s age, embryo quality, and others. criteria.

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