Patients' Preference for Number of Embryos Transferred During IVF/ICSI a Nigerian Experience

Background: The Human Fertilization and Embryology Authority is considering limiting the number of embryos that can be transferred to single embryo per cycle as has been done in several European countries; with the aim of reducing the rate of multiple pregnancies and its attendant complications following in vitro fertilization (IVF) / Intracytoplasmic sperm injection (ICSI). Objective: To determine the number of embryos patients' attending a fertility clinic in Nigeria; would prefer transferred during IVF/ICSI. Materials and Methods: Fifty four consecutive female patients who underwent IVF/ICSI procedures between May 2006 and April 2007 at the Port Harcourt Fertility Centre; Rivers State were interviewed using structured questionnaires. They were informed of all the obstetric and perinatal complications of multiple pregnancies and the advantages and trend towards single embryo transfer and then asked to choose the number of embryos (one; two or three) they would prefer transferred assuming similar implantation rates. Each respondent was allowed to give reason(s) for their choice. Design: Prospective; descriptive study. Results: Fifty one (94.4) of the respondents preferred the transfer of multiple (2 or 3) embryos. Only three (5.6) patients opted for single embryo transfer. Majority of the patients (31 or 60.8) preferred multiple embryo transfer because of their desire for twins while twenty (39.2) cited cost of IVF as their reason. Fifteen (29.4) patients saw multiple pregnancies as a compensation for their long periods of infertility. Conclusion: With the desire for twins and high poverty level in Nigeria; a policy of single embryo transfer might be difficult to implement. Health economic studies would be required to determine if the accumulative cost of taking care of twins/triplets is less; equal or outweighs the cost of several single embryo transfers

Placenta Praevia at the University of Port Harcourt Teaching Hospital: a Five Year Retrospective Study

Placenta praevia is a major cause of obstetric haemorrhage commonly encountered in clinical practice in our environment. It is a life threatening condition both to the mother and her baby.To report the incidence of placenta praevia and describe its clinical presentation; associated risk factors and maternal and perinatal outcomes over a five year period at the University of Port Harcourt Teaching Hospital; Port Harcourt. A cross-sectional study design was employed in the review of hospital records of all women who had placenta praevia and had labour/delivery services at the University of Port Harcourt Teaching Hospital between January 2002 and December 2006. Simple frequencies; cross tabulations and summary statistics were computed and analysed using SPSS version 11 soft ware. Chi-square test of significance was used to compare proportions at P-value- 0.05.One hundred and forty cases of placenta praevia were observed over five years; giving a yearly rate of 28 cases; and an incidence rate of 1.0out of 13;870. One hundred and eighteen women (93.6) had vaginal bleeding out of which 96 (76.1) were painless vaginal bleeding. The mean time from onset of vaginal bleeding to presentation in hospital was 10.98(+ 13.08) hours. The commonly identified known risk factors were induced abortion (50) and previous caesarean section (25). The average time of hospitalization was 13.83 (+ 9.76) days. One hundred and fourteen cases (90.5) had diagnosis confirmed by ultrasound scan while twelve cases (9.5) had Examination Under Anaesthesia (EUA). The mean gestational age at delivery was 37.1 weeks. Caesarean delivery was performed for 101 (80) cases; while 25 (20) had vaginal delivery. There was one maternal death. Thirty two (25.3) babies had birth asphyxia. The perinatal mortality rate was 61.5/1;000 total births. Placenta praevia is still an important obstetric problem in our environment. Despite the fact that most of our women present late; the availability of blood transfusion services; adequate manpower; ultrasound scan and neonatal intensive care facilities have contributed immensely to improve maternal and fetal outcome of this condition in our centre