Embryo Reduction

Today there is an increasing rate of infertility, with more and more couples going in for infertility treatments. With the advancement in science and technology, new treatments are becoming available. Over the years, data from studies has shown that the use of ovulation inducing agents has increased the number of multiple pregnancies about ten-fold. This is not the result of advanced assisted reproductive techniques like IVF, GIFT, and ZIFT, but from sole use of fertility enhancing drugs. It has been observed that use of drugs like Clomiphene citrate and Gonadotropins result in 6-8% and 15-53% cases of multiple pregnancy, respectively.

In the struggle to treat infertility selective embryo reduction may sound absurd, but it is a necessary evil to reduce foetal and maternal risks associated with high order multi-foetal pregnancies. Embryo reduction was introduced to avoid increased incidence of abortion and premature labour associated with multiple pregnancies along with their attendant problem

Several techniques have been suggested for embryo reduction. One such technique is the injection of potassium chloride into or in the vicinity of the foetal heart thereby causing it to stop functioning. In recent years a simpler and relatively safer method has been tried with the extensive use of ultrasonography. Around 6-8 weeks of gestation, embryo aspiration is done under ultrasound guidance through the vagina. A preliminary ultrasound is done to map the configuration and position of each embryo relative to the uterine cavity and to each other. The embryos not to be terminated are carefully identified so that no injury is caused to their sacs. The ones to be terminated are demarcated precisely since any attempt after a failed foetal reduction can lead to problems in the foetuses. It is done under general anaesthesia, under cover of antibiotics and the most easily accessible sac is chosen.

Dr. Rekha Khandelwal M.S.