Monochorionic triplet gestation after in vitro fertilization using donor oocytes: case report and review.

OBJECTIVE

To report on a patient with a monochorionic triamnionic triplet pregnancy after IVF with donor oocytes.

DESIGN

Case report.

SETTING

Academic tertiary care hospital.

PATIENT(S): A 42-year-old woman who underwent IVF with donor oocytes.

INTERVENTION(S): After failed IVF attempts, the patient chose to undergo treatment with donor oocytes. Her 23-year-old oocyte donor underwent standard controlled ovarian hyperstimulation. Retrieved oocytes were fertilized in vitro, and two embryos were transferred at the blastocyst stage.

MAIN OUTCOME MEASURE(S): Intrauterine pregnancy with single gestational sac and three fetal poles with cardiac activity.

RESULT(S): After extensive counseling with perinatologists about pregnancy complications, the patient elected to terminate at 10 weeks of gestation.

CONCLUSION(S): Several processes have been suggested to explain the increase in monozygotic twinning after IVF. These factors include advanced maternal age, superovulation, manipulation of the zona pellucida, and prolonged culture. It is possible that other factors may also play a role, especially in high-order monozygotic multiple pregnancies. All patients should be informed of the potential risk of a high-order multiple pregnancy after IVF, even when only one or two embryos are transferred.