Human Reproduction vol.13 no.9 pp.2377–2378, 1998 OPINION Why do some women undergo termination of pregnancy after successful IVF treatment? Leroy Edozien 1 Sharoe Green Hospital, Preston, UK 1 To whom correspondence should be addressed at: 14 Middlewood Drive, Stockport, SK4 2DF, UK This Opinion was previously published as Webtrack 23 on July 1, 1998 Infertility treatment is physically and psychologically stressful, and successful treatment brings enormous relief. Unfortunately, it appears that for a small but significant number of couples this relief is short-lived as they are constrained to have the pregnancy terminated. In the fertile female population, termination of pregnancy is traumatic; for the infertile couple it is even more traumatic. Apart from its traumatic effect on the couple, voluntary termination of a pregnancy conceived through in-vitro fertiliza- tion (IVF) and embryo transfer amounts to immense waste of resources that are inadequate to meet demand. It would, therefore, be instructive to find out why some IVF pregnancies are voluntarily terminated. This has not been addressed in the literature and, disappointingly, the national registries do not routinely include detailed information on terminations in their data. Obviously, some pregnancies are terminated for fetal anom- alies. It is important to know the uptake rate of prenatal diagnosis amongst women with IVF pregnancies, and what proportion of women with abnormal babies elect to terminate the pregnancy. This information would be invaluable for counselling. As a group, women with IVF pregnancies have a higher age-related risk of chromosomal anomaly than the general population, and require appropriate counselling when they are offered biochemical screening, amniocentesis or fetal normality scanning. It would appear that most couples would elect not to undergo invasive prenatal diagnostic tests, and that the reported incidence of congenital abnormalities mainly reflects structural anomalies, with the possible under-reporting of chromosomal anomalies. Termination of pregnancy for fetal anomaly is probably lower in IVF pregnancies than with spontaneously conceived pregnancies, but this needs to be confirmed by appropriate studies, preferably multi-centre studies given the small numbers involved. In a 6 year period there were only two (0.2%) terminations of clinical pregnancies resulting from IVF treatment in Australia, both terminations following prenatal diagnoses of © European Society for Human Reproduction and Embryology 2377 fetal abnormality (Australian IVF Collaborative Group, 1988). There were three (0.5%) induced abortions for congenital anomalies among the 644 intrauterine pregnancies resulting from 5209 IVF cycles in a Canadian unit over 10 years (Alsalili et al, 1995). In the French register there were 29 (0.4%) ‘therapeutic’ abortions for fetal anomalies between 1986 and 1990 (FIVNAT, 1995). Induced abortion rates are significantly higher in the USA where 1994 annual data from 249 units showed just over 5% induced abortions of IVF pregnancies (SART and ASRM, 1996). It is not known how many of these were for fetal anomaly. Induced abortions were especially high for pregnancies resulting from gamete intra- Fallopian transfer in women aged 40 years with no male factor (15.3%). Whilst fetal anomaly is the usual indication for termination of IVF pregnancies, there are cases where normal pregnancies have been voluntarily terminated. These are bound to be few, for the obvious reason that these are women who have climbed mountains in order to have a baby, but this same reason should motivate us to ask why they have been driven to such an extreme measure as terminating the much-desired pregnancy. Unfortunately this group has not been studied and national register statistics are not always sufficiently sub-stratified to isolate them. The French IVF register classifies abortions as ‘therapeutic’ (for fetal anomalies) or voluntary. Between 1986 and 1990 there were five (0.1%) voluntary terminations in 7024 clinical pregnancies (FIVNAT, 1995), but this publication does not address the reasons behind the terminations. The numbers may be small, but ideally the incidence rate should be zero. Figures from the Human Fertilisation and Embryology Authority (HFEA) register indicate that 81 IVF pregnancies, representing 0.7% of clinical pregnancies, were terminated between 1992 and 1994, and the number appears to be increasing (Table I). Some of the reported terminations are apparently selective reduction of multiple pregnancies but, strictly speaking, these should not be classified as terminations: the number of fetuses may have been reduced but the pregnancy itself has not been terminated. The table shows that the majority of cases are singleton pregnancies. Some of these might have been terminated on account of fetal anomaly, but it is useful to know the number of cases terminated for social, psycho- logical or religious reasons. If the terminations were mostly for fetal anomaly, we should expect an even distribution between pregnancies derived from fresh and frozen embryos, as congenital malformation rates are similar for fresh and