Effect of timing of multiple pregnancy reduction with ultrasound-guidance on abortion rate: a cohort study / 中华超声影像学杂志

Objective:To explore the relationship between different gestational weeks of transvaginal ultrasound-guided fetal reduction and abortion in patients with multiple pregnancies after embryo transfer, and to seek the best gestational age for fetal reduction.Methods:The datas of 486 pregnant women with multiple pregnancies after embryo transfer in the Second Hospital of Hebei Medical University from January 2012 to December 2020 were retrospectively analyzed. The relationship between gestational weeks of fetal reduction and abortion rate was analyzed by curve fitting, threshold effect and multivariate logistic regression analysis.Results:After adjusting for age, infertility type, infertility years, number of births, abortion times, body mass index(BMI), various infertility and sterility factors, endometrial thickness on the day of transformation, monozygotic twins and reduction methods, when the gestational age was less than 8.43 weeks, the abortion rate increased significantly with the increase of reduction gestational age, and the abortion rate increased by 221% ( OR=3.21, 95% CI=1.47-6.99, P=0.003 3). When the gestational age of reduction ≥8.43 weeks, the abortion rate tended to be stable and did not increase ( OR=0.81, 95% CI=0.54-1.22, P=0.317 7); meanwhile, in stratified analysis, the OR value of the BMI ≥24 kg/m 2 was 12.38, and that of BMI <24kg/m 2 was 1.91, P=0.053 9. Conclusions:There is a non-linear relationship between gestational age and abortion rate of ultrasound-guided multiple pregnancy reduction in patients with embryo transfer. The abortion rate increases significantly with the increase of gestational age before 8.43 weeks of gestation. It is recommended to carry out the operation as early as possible before 8 weeks of pregnancy. The effect of BMI on the abortion rate of patients with fetal reduction needs further study.

Single embryo transfer and multifetal pregnancy reduction: perception and attitude of women seeking assisted reproduction in Nigeria

Background: In-vitro fertilization (IVF) is associated with increased multiple pregnancy and its attendant complications. This study evaluates the attitude and acceptance of single embryo transfer (SET) and multifetal pregnancy reduction (MFPR) by clients assessing assisted reproduction in this region.Methods: A cross sectional survey of patients selected for IVF was conducted. Information on demography, knowledge of IVF procedure and their perception, attitude and acceptability of multiple pregnancy as well as their knowledge, attitude and perception to single embryo transfer and multifetal pregnancy reduction were extracted for statistical analysis.Results: Seventy-three women participated in the study. The mean age was 39 years and mean duration of infertility was 8.6 years. Only 3 (4.1%) respondents agreed to have SET as the overwhelming majority (70) 95.9% preferred 2 or more and they felt the more number of embryo transferred the better the chances of achieving pregnancy. Similarly most respondents, 38.4% (28) did not accept MFPR. Most respondents considered age (63%) and duration of infertility (78.1%) as major influencing factor for rejecting SET. Over 75% of respondents said they will still accept multiple embryos transferred despite knowledge of the possible complications.Conclusions: While most infertile women in our sub region appear to recognize the risks with multiple pregnancy, they are less interested in SET or MFPR because they perceive more embryos transferred as a means to maximize treatment outcome. Government funding, client education and a blastocyst transfer protocol may improve acceptability as well as overall preference for less number of embryos transferred in our environment.

Experience of Decision Making about Selective Fetal Reduction among Women Who Conceived through Assisted Reproductive Techniques / 임상간호연구

PURPOSE: This study aimed to explore and understand the experience of decision making among women undergoing or forgoing selective fetal reduction who have higher-order multiple pregnancies through assisted reproductive techniques. METHODS: A qualitative study was conducted from August 1, to October 30, 2013. Eight participants were interviewed and the interviews were audio-recorded and transcribed verbatim. Six persons participated in in-depth interviews in person and two participated over the telephone. A thematic analysis was conducted. RESULTS: Four themes were identified and carefully named: Confusion after higher-order multiple pregnancy; Obstacles to choice: Uncertain safety; Weighing between reality and ideality and; Influences of medical professionals. CONCLUSION: The results demonstrated a wide range of factors considered by women when making decisions about selective fetal reduction, and mothers'feelings of conflict and distress in the decision-making process. The results suggest that it is important for nurses to provide emotional support and consolation, in addition to sufficient information. These findings will help nurses improve their counseling techniques by understanding the situation of infertile couples.

Prediction of Amnionicity Using the Number of Yolk Sacs in Monochorionic Multifetal Pregnancy

The purpose of this article was to evaluate the accuracy of predicting amnionicity using the number of yolk sacs by diagnostic ultrasound examination in monochorionic (MC) multifetal pregnancies between 7 + 0 and 9 + 6 gestational weeks. A total of 97 patients with MC multifetal pregnancies underwent early ultrasound examination from 2004 to 2014 at Cheil General Hospital and Women's Healthcare Center. All patients for whom the number of yolk sacs was reported were included in this study. We compared the number of yolk sacs with amnionicity confirmed by an intertwine membrane. Overall, there was a 9.3% (9 cases) discrepancy in number of yolk sacs and amnionicity (4.3% for monochorionic diamniotic, 36.4% for monochorionic monoamniotic, and 33% for monochorionic triamniotic). Among the 9 cases with discrepancies, 4 cases with 2 yolk sacs were confirmed as monoamniotic pregnancies and 4 MC twin pregnancies showing a single yolk sac were diagnosed as diamniotic twin pregnancies. One case with 2 yolk sacs was identified as a triamniotic triplet pregnancy. In 9.3% of MC gestations, the number of yolk sacs was not correlated with the number of amnions in our study. To determine amnionicity in MC multifetal pregnancies, we recommend careful evaluation not of the number of yolk sacs but the presence or absence of intertwine dividing membrane after 8 gestational weeks.

Pregnancy outcomes and nursing of 204 cases of multiple pregnancies undergoing transvaginal multifetal pregnancy reduction / 现代临床护理

Objective To analyze the pregnancy outcomes of 204 cases of multiple pregnancies following early transvaginal fetal reduction and sum up the experiences of peri-operation nursing care. Methods A total number of 204 twin and triplet pregnancies under treatment in the reproductive medical center from Jan. 2009 to Dec. 2012 were involved in the study. All patients underwent transvaginal multifetal pregnancy reduction during pregnancy of 7 to 8 weeks . The pregnancy outcomes were analyzed , and the nursing measures including preoperative preparation , intraoperative cooperation and postoperative nursing were analyzed . Result The successful rate of multifetal reduction was 100%, and the rate for taking the infants home reached 77.0% ~ 92.3%. Conclusion The outcomes of multifetal reduction for the twin or triplet pregnancy are good . Such nursing measures as perioperative mental care , intraoperative cooperation and postoperative follow-up are key to the alleviation of mental pressure during operation , raise of the success rate of fetal reduction and prevention of postoperative complications.

Perinatal Outcomes of Pregnancy with Assisted Reproductive Technology / 대한주산의학회잡지

Assisted reproductive technology (ART) is defined as any treatment and procedure associated with the handling of human oocytes, sperms or embryos for the purpose of establishing a pregnancy. As the use of ART has been dramatically increasing over 3 decades and the number of babies born by ART are increasing, it is important to consider perinatal outcomes of pregnancies with ART including structural abnormalities, growth and development, as well as the clinical pregnancy rate and the live-birth rate with regard to the parameters assessing the success of ART. Clinicians should be aware of maternal and perinatal outcomes in pregnancy with ART and infertile couples considering ART should be thoroughly counseled on these issues. In this article, the perinatal outcomes of pregnancy with ART will be reviewed.

A Successful Delayed-Interval Delivery without Cerclage Operation after One Fetal Delivery in a Case of Twin Pregnancy / 대한주산의학회잡지

The incidence of multifetal pregnancies has significantly increased because of progress of assisted reproductive technologies. Preterm delivery is the most common and significant obstetrical problem in multifetal pregnancies. When the first twin of mutifetal pregnancy is prematurely delivered at previable gestational age, the success of delayed interval delivery of the second twin can improve the neonatal outcome for the remaining fetus. The optimal management of delayed interval delivery is not defined. Tocolysis, prophylactic antibiotics, and cervical cerclage are generally used. I present a case of delayed interval delivery in twin pregnancy with an interval of 89 days. The first twin was delivered at 21.3 weeks of gestation and delayed delivery of the second twin was succeeded by conservative treatment without cervical cerclage. This case is the longest interval case in Korea.

A comparison among three ultrasound-guided transvaginal embryo reduction techniques in multifetal pregnancy / 中国微创外科杂志

Objective To compare clinical effects among three techniques of multifetal pregnancy reduction(MFPR) guided by transvaginal ultrasonography through vaginal approach.Methods Under the guidance of transvaginal B-ultrasonography,99 cases of multiple pregnancy following assisted reproductive technique underwent three different methods of embryo reduction: drug injection directly to the pregnancy sac(Drug Group),simple embryonic bud aspiration(Aspiration Group),and combined use of drug and aspiration(Combination Group).Results The gestational age at the procedure ranged 41~88 days(mean,58.9?8.7 days).The success rate of the procedure on one session was 100%(99/99).Short-term outcomes included 3 cases of abortion(3.0%).On continuing follow-up observations in 73 cases,the incidences of abortion and premature delivery were 11%(8/73) and 12%((9/73)),respectively.No statistical differences were seen among the three groups in rates of abortion,premature delivery,and full-term delivery(?~2=1.131,P=0.889).In the Aspiration Group,however,the exposure time to B-ultrasound and the operative time were significantly shorter than those in the other two groups.The gestational age at the procedure was 61.7?8.2 days in the Drug Group,48.8?2.7 days in the Aspiration Group,and 56.7?7.2 days in the Combination Group,respectively,with significant differences between the Aspiration Group and other two groups(F=19.36,P=0.000).The number of embryos reduced was associated with pregnancy outcomes: the abortion rate was remarkably higher in patients receiving the reduction of more than two embryos than only one embryo(?~2=6.415,P=0.040).Conclusions Ultrasound-guided multifetal pregnancy reduction is a safe,effective and microinvasive procedure.It is recommended that simple embryonic bud aspiration be used for multifetal pregnancy before 7 gestational weeks,combined use of drug injection and aspiration for multifetal pregnancy at 7~9 gestational weeks,and drug injection to the pregnancy sac for multifetal pregnancy after 9 weeks.

A Case of Delayed Delivery of Second Twin / 대한산부인과학회잡지

With the introduction of assisted reproductive technologies, the incidence of multifetal pregnancies has significantly increased. In vaginal delivery for multifetal pregnancy, the delivery of the second fetus usually follows the first in few minutes. However in rare circumstances, the delivery is delayed for days due to disappearance of uterine contraction after delivery of the first fetus. Successful prolongation of the interdelivery time may improve the neonatal outcomes of the remaining fetus (es), particularly in the cases of extremely premature gestation. We present a case of a delayed delivery of second twin with an interval of 48 days.

Factors Affecting Complete Fetal Loss Following Multifetal Pregnancy Reduction / 대한불임학회지

OBJECTIVE: To identify the factors affecting the complete fetal loss following multifetal pregnancy reduction (MFPR). DESiGN: Retrospective clinical study. METHODS: A total of 256 consecutive treatments of MFPR in iVF-ET cycles performed between 1992 through 2000 in Samsung Cheil hospital were analyzed. MFPR was done around 8 weeks of gestation by transvaginal ultrasono-guided aspiration in multiple pregnancies and reduced to singleton or twins. Stepwise logistic regression was performed to identify the factors affecting the final outcome of pregnancy after MFPR. Dependent variable was complete fetal loss and the independent variables were maternal age, paternal age, initial number of gestational sac (iGSNO), initial number of fetal heart beat, the number of remaining live fetus after MFPR, and chorionicity. RESULTS: The total survival rate was 87.9%, and total fetal loss rate after MFPR was 12.1%. Total fetal loss occurred within four weeks from MFPR procedure was 1.95%. Total loss occurred after four weeks of procedure and before 24 gestational weeks was 8.2%. Seventy nine percent (202/256) of pregnancies delivered after 34 weeks of gestation. The survival rate of pregnancies reduced to singleton was significantly higher than that of pregnancies reduced to twins (93.5% vs. 86.7%, p<0.05). The mean (+/-SEM) gestational age at delivery was 36.2+/-1.0 and 34.1+/-0.5 weeks for pregnancies reduced to singletons and twins, respectively (p=0.065). Logistic regression analysis revealed that the maternal age, the number of initial gestational sac (iGSNO), and the number of remaining live fetus after MFPR significantly affected the rate of total fetal loss (Z = 0.174'age + 0.596'iGSNO + 1.324'remaining fetuses-12.07), (p<0.05). CONCLUSiONS: MFPR seems to be a relatively safe and efficient method to improve the obstetric outcome in high order multiple pregnancy. Because the maternal age, the number of initial gestational sac and the remaining live fetuses after MFPR affect the total fetal loss rate, restriction of the number of transferred embryos according to the age and MFPR to singleton fetus could be considered for the better obstetric outcome in iVF pregnancy.

Genetic amniocentesis after multifetal pregnancy reduction / 대한산부인과학회잡지

OBJECTIVE: This study is directed to evaluate the pregnancy loss rate resulting from genetic amniocentesis after multifetal pregnancy reduction. METHODS: From March 1998 to April 1999, total 145 patients with multifetal pregnancy were included in this study. Pregnancy loss in a study population of 44 patients who underwent genetic amniocentesis after multifetal pregnancy reduction were compared with a control group of 99 patients who did not have genetic amniocentesis after multifetal pregnancy reduction. RESULTS: The pregnancy loss rate in patients who underwent genetic amniocentesis after multifetal pregnancy reduction was 2.2% (1/44) compared with 4% (4/99) in the controls (P>.05). In the study group, one woman lost her pregnancy at 19 weeks' gestation, 3 weeks after the genetic amniocentesis, and the predisposing factor was spontaneous rupture of membranes. CONCLUSION: Genetic amniocentesis following multifetal pregnancy reduction does not increase the risk of pregnancy loss.

Fetal Reduction in Multifetal Pregnancy: Ethical Dilemmas

As a result of the increased use of drugs that enhance fertility, and the advent of in vitro fertilization and embryo transfer over the last 2 decades, the incidence of multifetal pregnancies has increased exponentially. In parallel with this increase methods of care for women carrying multiple fetuses have become more complex and well developed. Importantly, it has become obvious that in the case of such pregnancies the rates of mortality and morbidity of both fetuses and mothers, particularly in cases where four or more fetuses are involved, are extremely high. Improvements in the techniques of assisted fertilization should result in fewer yatrogenic multifetal pregnancies and a commensurate decrease in related risks. Fetal reduction seems to be an acceptable method of improving maternal and fetal outcome in high order multiple pregnancies despite the many unresolved medical and ethical dilemmas.

Perinatal Outcome of Reduced Twin Pregnancies from Triplet by Multifetal Pregnancy Reduction in Patients underwent In Vitro Fertilization and Embryo Transfer / 대한산부인과학회잡지

OBJECTIVE: To investigate the perinatal outcome and complications of reduced twin pregnancies from triplet by multifetal pregnancy reduction (MFPR) in patients who underwent in vitro fertilization and embryo transfer. MATERIALS AND METHODS: From January 1995 to December 1999, a total of 71 twin pregnancies were included in this study. The patients were grouped into the MFPR group (n = 19) and the non-MFPR group (n = 59). The pregnancies in the MFPR group were reduced to twin from triplet by the MFPR. MFPR was performed by transvaginal sonography-guided fetal aspiration or mechanical trauma. The obstetric and perinatal outcomes were compared between the two groups. Statistical analysis was performed using Student's t-test, Fisher's exact test, and kappa2 test as appropriate. Statistical significance was defined as p < 0.05. RESULTS: There were no significant differences in mean gestational age and distribution of gestational age between the two groups. However, the fetal loss rate before 24 weeks of gestation was significantly higher in the MFPR group than the non-MFPR group. We did not find any significant differences in mean birth weight and weight discordancy between the two groups. There were no differences in obstetric and perinatal outcomes between the MFPR and non MFPR groups as well. CONCLUSIONS: These data suggest that pregnancy outcome of reduced twin pregnancies from triplet by MFPR in patients underwent IVF-ET might be comparable to that of non-reduced twin pregnancies.

Pregnancy Outcomes after Transvaginal Selective Fetal Reduction in Multifetal Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the maternal and fetal outcomes after transvaginal selective fetal reduction(SFR) in multifetal pregnancy. MATERIALS AND METHODS: Transvaginal SFR using fetal intracardiac puncture with KCl injection and aspiration of amniotic fluid was performed in 58 multifetal pregnancies achieved after assisted reproductive technology(ART). After transvaginal SFR, 55 twin and 3 singleton pregnancies were evaluated and analyzed retrospectively with the medical records of mothers and babies. RESULTS: Of 58 cases, abortion within 4 weeks after SFR occurred in 1 case(1.7%). Miscarriage of all fetuses occurred in 8 cases(13.8%) from 4 weeks after SFR until 24 weeks of gestation. Perinatal death occurred in 8 newborns from 5 mothers due to extreme prematurity in 7 cases and anencephaly in 1 case. Take-home baby rate, that is, discharge with at least 1 healthy baby, was 77.6%(45/58). CONCLUSION: Transvaginal SFR is an acceptable and effective management option in the cases of excessive multifetal pregnancy after infertility treatment. The ultimate successful outcomes of reduced multifetal pregnancy may be enhanced by more extensive experience with SFR.

Multifetal pregnancy reduction (MFPR) after infertility treatment

From January 2001 to September 2001, MFPR were performed for 26 multifetal pregnancies after infertility treatment. Transvaginal selective embryo aspiration was performed at the ninth week of gestation, without KCl injected in the vicinity of the fetal heart. The mean number of viable embryos before and after reduction was 3.4 and 2.1. There were no complications recorded after the procedure such as vaginal bleeding, amniotic leakage and infection. The rate of miscarriage before 24 weeks was 7.1%. The mean gestation length and the mean birth weight were 36.22.8 weeks and 2360.0349.4g for the twins, respectively, and 30.67.6 weeks and 2066.7177.9 g for the triplets. Results from this study were comparable to the other studies worldwide. Preliminary data from this study showed that early transvaginal embryo aspiration without using KCl is a safe, effective method to improve obstetric outcome of multifetal pregnancies after infertility treatment.

Clinical Results of Transvaginal Multifetal Pregnancy Reduction According to the Gestational Period / 대한산부인과학회잡지

OBJECTIVE: To compare the pregnancy outcomes of transvaginal multifetal pregnancy reduction (MFPR) according to the gestational period when the procedure was performed METHODS: From January l995 to February 1998, total 27 patients with multiple pregnancy were included in this study. The patients were grouped to early MFPR group (8 weeks, n=ll) according to the gestational age that MFPRs were performed. All MFPRs were performed by transvaginal sonography-guided fetal aspiration or mechanical trauma. The complete pregnancy loss rate before 24 weeks of gestation, spontaneous loss of embryo, procedure-related complication, gestational age at delivery, and pregnancy complication were compared between the two groups. Statistical analysis of data was performed using Students t-test and Fishers exact test as appropriate. Statistical significance was defined as p<0.05. RESULTS: There was no significant difference in the complete pregnancy loss rate between the early MFPR group (6.3%) and the delayed MFPR group (27.3%). The incidence of partial spontaneous loss of embryo in the two groups were not differed significantly (6.3% vs. 18.2%). The procedure-related complication of the delayed MFPR group (36.4%) seemed to be higher than that of the early MFPR group (6.3%), however there was no statistical difference (p=0, 07). Especially, all 3 patients in whom the MFPR was performed after 10 weeks suffered from the procedure-related complication. The mean gestational age at delivery of the two groups were not differed significantly (36.3+2.8 weeks vs. 37.0+1.3 weeks). There was also no significant difference in the mean birth weights of the two groups (2378.8+563.7 gm vs. 2427.1+436.2 gm). CONCLUSION: Although there was no statistically significant difference, the early transvaginal MFPR might be a safe and useful method without significant adverse complications compared to the delayed MFPR.

Perinatal Outcome in Twin Pregnancies after in Vitro Fertilization and Embryo Transfer : Comparison between Reduced and Non-reduced Twins / 대한산부인과학회잡지

Multifetal pregnancy reduction(MFPR) has been suggested to improve pregnancy outc-ome in multifetal pregnancies with three or more fetuses after assisted reproductive techn-ology(ART) such as IVF-ET program, and now it seems to be a rather safe and effective mothod to reduce perinatal loss associated with multifetal pregnancies. To investigate the effectiveness of MFPR, the perinatal outcome of twin pregnancies in IVF-ET patients was analyzed in 3 groups : Group I-12 infertile patients who had conceived more than quadru-plet pregnancy and underwent MFPR to twin pregnancy, Group II-29 patients who had conceived triplet pregnancy and underwent MFPR to twin pregnancy, and Group III-30 pat-ients who had conceived twin pregancy initially and served as control group. Among 3 gr-oups, fetal loss rate before 24 weeks of gestation, pregnancy non-reduced, complications, gestational age at delivery, and birth weight were compared. Fetal loss rate after MFPR was significantly higher in Groups I(41.7%) and Group II(17.2%) compared with Group III(3.3%), and positively correlated with the number of fetuses before MFPR in Groups I and II. However, pregnancy complication rate was not significantly different among 3 groups(41.7%, 48.3%, and 36.7%). After exclusion of fetal loss cases before 24 weeks, mean gestational age at twin delivery and mean birth weight were not significantly different among 3 groups(36.2 weeks, 36.6 weeks, and 36.1 weeks ; 2.37 kg, 2.45 kg and 2.47kg).In conclusion, MFPR in multifetal pregnancies is an ethically justified procedure that may improve perinatal outcome in cases of multifetal pregnancies.

Transabdominal Selective Fetal Reduction in Multifetal Pregnancy / 대한산부인과학회잡지

Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.

The Affects of the Initial Fetal Number on Pregnancy Outcomes before Multifetal Pregnancy Reduction / 대한산부인과학회잡지

Multifetal pregnancy reduction(MFPR) appears to be an efficacious method for impro-ving the perinatal outcome of high order multifetal pregnancies(three or more fetuses). But it is controversial that larger initial fetal number before MFPR affects pregnancy outcomes adversely. The purpose of this study is to determine the affects of the initial fetal numbers on pregnancy outcomes and to compare the obstetrical outcomes according to the initial fe-tal numbers. Eighty four patients who conceived triplet or more by assisted reproductive technology(ART) in our infertility clinics and underwent MFPR to twins between January 1993 and December 1995. Sixteen patients were lost follow-up. Among the remaining 68 patients, four pateints were excluded from this study because of the pregnancy loss before 20 weeks gestation. The patients(n=64) were divided into three groups by the initial fetal number before reduction. 33 patients with triplet gestations(group 1), 18 patients with qua-druplets gestations(group 2), and 13 patients with quintuplet or more gestations(group 3) were retrospectively enrolled. Gestational age at delivery and birthweights were compared according to the initial fetal numbers. The mean maternal age was similar in each three groups. The results were as follows : 1) Although there was a trend of decreasing gestati-onal weeks at delivery and decreased birthweight in each groups(mean+/-SEM : 36.9+/-0.3, 34.7+/-1.3, 32.7+/-1.9 and 2,600+/-58, 2,161+/-215, 1,855+/-249 respectively), there were no stati-stical difference between group 1 and group 2, but there were significantly lower in group 3, compared with group1(p < 0.05). 2) The incidence of birth before 36 weeks gestation in each group 1, group 2, and group 3 were 12.1%, 38.9%, and 53.8% respectively(p < 0.05). 3) The incidence of low birthweight( < 2,500gm) in each group 1, group 2, and group 3 were 30.3%, 55.6%, and 69.2% respectively(p < 0.05). In conclusion, although MFPR reduced the high order multifetal pregnancy into twin pregnancy, the duration of gestation and the birth weight of newborn were still had a tendency of shortening and low respectively in high order multifetal pregnancy. Therefore strict control of the number of dominant follicles during superovulation and the number of transfered embryo in in vitro fertilization(IVF) is required for improving the pregnancy outcomes in ART.