Multiple pregnancy induction and selective fetal reduction in high genetic risk couples

Couples at risk for an inherited disorder often have severalpregnancy interruptions because of affected fetuses and difficultyin achieving their desired family. We evaluated the efficiencyand acceptability of selective fetal reduction after chorionicvillus sampling (CVS) of multiple pregnancy induced by ovarianstimulation and gamete intra-Fallopian transfer (GIFT). Thisapproach has been offered to nine patients at risk of Mendeliandiseases and one patient carrier of reciprocal translocation.The acceptance has been very high (90%). One patient at riskof an autosomic recessive disease opted for artificial donorinsemination, one conceived spontaneously, and one was a poorresponder to ovarian stimulation. Seven patients actually underwenta single GIFT procedure with six achieving pregnancy (86%),all but two being a multiple pregnancy (67%). All pregnanciesconcluded uneventfully at term and newborns were alive and healthy.Prenatal diagnosis, including fetal karyotyping in all cases,was performed at 8.5–11.5 weeks of gestation and confirmedeither on amniotic fluid aspirated at reduction or at birth.The number of fetuses was reduced to one or two because thegenetic disease was present and/or to reduce the risk of prematuredelivery and improve the likelihood of successful pregnancy.The new approach seems to be highly effective and might be considereda practical and useful alternative to preimplantation geneticdiagnosis.