1. Can we further reduce multiple pregnancies in Belgium?
Prof. Diane De Neubourg
Center for Reproductive Medicine - Antwerp University Hospital

2. On behalf of the College of Physicians for Reproductive Medicine.
BSRM
Prof. Diane De Neubourg
Center for Reproductive Medicine - Antwerp University Hospital

3. OUTLINE
What is the actual situation?
Where are we compared to Europe (EIM 2013)?
Can we do better? Scope for improvement?
Analysis of the “remaining twins”
Conclusions & recommendations

4. What is the actual situation? Belrap data 2015

5. Own fresh cycles 2015: number of deliveries

6. Own cryo cycles 2015: number of deliveries
6% twins

7. Fresh and thawed oocyte recipient cycles 2015: number of deliveries

8. Fresh and thawed oocyte recipient cycles 2015:
number of deliveries

9. Where are we compared to Europe?
Assisted reproductive technology in Europe 2013: results generated from European registers by ESHRE
By the European IVF-monitoring consortium (EIM) for ESHRE
Calhaz-Jorge et al., Hum Reprod 2017, 32; 10:

10. Calhaz-Jorge et al., Hum Reprod 2017, 32: 1957-73

11. Calhaz-Jorge et al., Hum Reprod 2017, 32: 1957-73

12. What about the remainig twins? Analysis of the Belrap data 2010-2015

13. Fresh cycles Number of twins (absolute figures) 2010-2015
Rank of the cycle
Age category (<36; 36-37; 38-39; 40-42)
Day of transfer (cleavage stage versus blastocyst stage)
Twin births after a previous IVF birth.

20. Fresh cycles Percentage of twin births compared to all births
Rank of the cycle
Age category (<36; 36-37; 38-39; 40-42)
Day of transfer (cleavage stage versus blastocyst stage)

23. Cryo cycles Number of twins (absolute figures) 2010-2015
Rank of the cycle
Age category (<36; 36-37; 38-39; 40-42)
Twin births after a previous IVF birth.

27. Cryo cycles Percentage of twin births compared to all births 2010-2015
Age category (<36; 36-37; 38-39; 40-42)

29. Conclusions Own fresh cycles (2010-2015)
The highest number of twin births are in the age category <36 in all the cycle ranks and in age category in first and second cycles.
Multiple birth rate remains high in all age categories until 40 (range 10-20% over all ranks).
Most twin births still come from cleavage stage embryos, but the proportion twin births after D2-3 versus D5-6 is changing.
Multiple birth rate after D5-6 transfer is higher than on D2-3 high in all age categories.
There is an important number of twin births in 2015 after a previous IVF live birth ( ) particularly in <36 age group.

30. Conclusions Own cryo cycles (2010-2015)
The highest number of twin births are in the age category <36 with an important number of twin births after a previous IVF pregnancy.
Multiple birth rate is more or less the same in all age categories until 42 years of age (range 7-10%).

31. Recommendations SET for women <36
at least in first 3 to 4 fresh cycles
all cryo cycles
D5 transfer
After a previous IVF birth
SET for women in first 2 fresh cycles (consider in cryo cycles and after a previous birth).
Bear in mind that the twin birth rate is high for all age categories until 40 (42) when counselling the individual patient!

32. THANK YOU