Transvaginal ultrasound in selective embryo reduction for multiple pregnancy.

Ovulation induction for the treatment of infertility is known to carry the risk of inducing multiple gestations, with attendant high perinatal morbidity and mortality. Selective reduction of the number of fetuses in a multiple gestation to reduce this risk, using transvaginal ultrasound, is a recent technological development. Six patients (three with quadruplets and three with triplets) underwent selective embryo reduction in the first trimester using real-time transvaginal ultrasound. Potassium chloride was used for intrathoracic injection. One of the procedures was complicated by chorioamnionitis 48 hours later, necessitating termination of pregnancy. Transvaginal sonographically directed selective reduction represents an important addition to the management of unplanned multiple pregnancy resulting from infertility treatment. The procedure is not without risks, and these must be weighed against potential benefits.

Endometrial thickness and growth during ovarian stimulation: a possible predictor of implantation in in vitro fertilization.

The present study was undertaken to evaluate endometrial thickness and the amount of endometrial growth (delta) in patients who conceived during in vitro fertilization (IVF) (n = 36) compared with matched women who did not conceive (n = 72). Estradiol (E2) and endometrial thickness were measured daily from cycle day 10 to the day after human chorionic gonadotropin (hCG). Mean endometrial thickness and E2 levels on cycle day 10 did not differ. On the day before ovum retrieval, significantly thicker endometrium was observed in the pregnant than in the nonpregnant women (8.6 +/- 0.3 [SEM] and 7.1 +/- 0.3 mm, respectively; P less than 0.0005), whereas the mean E2 levels did not differ. The delta endometrial growth was greater in the women who conceived than in the nonpregnant group (4.3 +/- 0.2 and 2.5 +/- 0.2 mm, respectively; P less than 0.0005). The fertilization rate and serum E2 levels did not correlate with endometrial thickness nor with delta endometrial growth. Our data suggest that the amount of endometrial growth during ovarian hyperstimulation and the endometrial thickness on the day before oocyte retrieval deserve further study as possible predictive parameters for implantation.