| OBJECTIVE:With the widely use of assisted reproductive technology,multiple pregnancies have been increased highly.Multiple pregnancies have become one of the severe complications of ART.Recent years,the ART authorities are concerning more and more about the prevention of it since most studies have reported the worse outcome of these women.(1)To understand the risk factors involved in multiple pregnancy is very important for us to avoid it during our work.(2) We know spontaneous multiple pregnanacies belong to the high risk pregnany,the infertility patients have many problems in pregnancy which may convert to the worse outcome.How are the infertility patients' pregnancy outcome compare with the general population?For our IVF practitioners the well understanding of this is of great importance for the sake of appropiate management of the multiple pregnancy.enhance the caring of these women during the pregnancy and improve their outcome.Basic of the above two aspects we design this study to investigate the risk factors involved in multiple pregnancies and to study the outcome of multiple pregnancies derived from ART procedure.We expect the results can be used to instruct our clinical work so as to avoid multiple pregnancies following ART and to improve the consequent outcome.MATERIALS AND METHODS:All multiple pregnancies during 2001.1.1～2003.12.31 were analyzed.There were 20 multiple pregnancies during our study period.1.To investigate the risk factors associated in multiple pregnancies the studying cases were the 20 multiple pregnancies.We selected 30 singleton pregnancies for the control group.They were analyzed regarding various factors associated with the IVF/ICSI-ET course.2.For the study of the pregnancy outcome,we use the case-control study . Each IVF case was matched to two control cases.We compared various maternal and neonatal complications between the two groups.3.The data were collected by extracting the obstetric and neonatal records and part information were got from the patient through telephoning.RESULTS:1.After comparing the multiple pregnancies and the singleton pregnancies we found significant difference in the mean number of embryo transferred,the mean number of embryo cells transferred,the mean number of oocytes retrieved,the mean number of fertilized oocytes,the mean number of cleavage oocytes(3.6±0.9vs2.6±0.8,p=0.000;7.8±2.0vs6.5±2.1,p=0.006;11.2±4.4vs7.8±4.4,p=0.008;8.3±3.1vs5.6±3.8,p=0.006;8.0±3.2vs5.5±3.7,p=0.008,respectively).No significant difference were found in the mean age of the patients,the durrence of infertility,the number of therapy,the day of embryo transfer,the mean grade of embryo transfer. Furthermore the mean number of embryo transferred,the mean number of embryo cells transferred,the mean number of oocytes retrieved,the mean number of fertilized oocytes,the mean number of cleavage oocytes were analysed with the multiple factors Logistic regression,and at last only the mean number of embryo transferred,the mean cells number of embryo transferred were remained in the last equation.The ORs are 3.810(95%CI 1.612-9.004),1.573(95%CI 0.945-2.620) respectively. 2.With regarding of maternal and neonatal outcome, IVF/ICSI-ET cases were more likely to have preterm labor(88%vs41%,p=0.002).And there were no significant difference in the pregnancy-induced hypertension,gestational diabetes mellitus,placenta previa,abruptio placentae,preterm premature rupture of membranes between the two groups.Gestational age of the IVF/ICSI-ET cases were significant shorter than the control(34±3wk vs 36±1.5wk,p=0.004).The two groups were almostly all ended with cesarean delivery, there were no significant difference between the two groups in the cesarean delivery incidence despite both were higher than other studies(94%vs91%,p>0.05). The incidences of low birth weight,neonatal respiratory distress syndrome,the mechanical ventilation needing,1 minute Apgar score<7 were significant higher in the IVF/ICSI-ET group than the spontaneous g...
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