Trizygotic quadruplet pregnancy following in-vitro fertilization: an additional factor against replacement of three embryos in young patients?

A study of a 25 year old woman with a previous history of tubal damage, ectopic pregnancy and unsuccessful tubal surgery is reported. Following in-vitro fertilization (IVF) treatment, four viable fetuses were revealed by ultrasound scan at 10 weeks gestation. Two shared the same gestational sac, thus establishing a trizygotic quadruplet pregnancy. The implications of monozygotic twinning in humans are discussed. It is concluded that embryo splitting and its consequences should be seriously considered when multiple embryo transfer in young patients is contemplated.