Multiple Gestations and Assisted Reproductive Technology

Darcy E. Broughton*, Emily S. Jungheim

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations


Many are aware of the recent “epidemic of multiples” in industrialized nations, with a multiple birth rate that has increased by 76% in the past three decades. The main contributors to this increase are increased utilization of assisted reproductive technologies and an increased risk of spontaneous twinning in women delaying childbearing. Multiple gestations are at high risk for both maternal and fetal morbidity and mortality, which increase as fetal number increases. Zygosity and chorionicity are important predictors of perinatal morbidity, with monochorionic diamniotic and monochorionic monoamniotic twins at higher risk. There is evidence that the risk of monozygotic twinning is increased in IVF, etiologies may include zona pellucida manipulation and extended in vitro culture. Most neonatal complications in multiple gestations are sequelae of prematurity, including low birth weight, respiratory distress syndrome, NICU admission, intraventricular hemorrhage, and necrotizing enterocolitis. Up to 80% of women with multiple gestations experience antepartum complications, which include preterm labor, PPROM, and placental abruption. Women carrying multiples are at increased risk for the three major causes of maternal mortality: postpartum hemorrhage, venous thromboembolism, and hypertensive disorders. Multiple gestations are also associated with increased financial and psychosocial costs. Strategies for decreasing the rate of multiples resulting from ART include increasing the number of single embryo transfers performed in IVF and using “low and slow” protocols for superovulation cycles with gonadotropins. Multifetal pregnancy reduction can be performed to decrease the fetal number and lower the risk of morbidity, although the procedure does involve some medical and psychological risk.

Original languageEnglish (US)
Title of host publicationAvery's Diseases of the Newborn, Tenth Edition
ISBN (Electronic)9780323401395
ISBN (Print)9780323401739
StatePublished - Jan 1 2017
Externally publishedYes


  • assisted reproductive technology
  • Assisted Reproductive Technology (ART)
  • in vitro fertilization
  • multifetal reduction
  • multiple gestations
  • single embryo transfer
  • twins
  • zygosity

ASJC Scopus subject areas

  • Medicine(all)


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