Dichorionic quadramniotic quadruple gestation with monochorionic triamniotic triplets after two embryos transfer and selective reduction to twin pregnancy: case report.

OBJECTIVE

To report a dichorionic quadramniotic quadruple gestation with monochorionic triamniotic triplets after intracytoplasmic sperm injection (ICSI) treatment and transfer of two embryos.

DESIGN

Case report.

SETTING

Academic reproductive medicine center.

PATIENT(S): A 28-year-old nulligravida who underwent first ICSI cycle.

INTERVENTION(S): After 4 years of primary infertility for andrologic subfertility, the patient underwent her first ICSI cycle, with transfer of two fresh embryos on day 3.

MAIN OUTCOME MEASURE(S): Transvaginal sonogram performed at 5 weeks after embryo transfer showed a dichorionic quadramniotic quadruple gestation with monochorionic triamniotic triplets and a singleton.

RESULT(S): After extensive counseling, the couple decided to proceed to a selective reduction of two of monochorionic triamniotic triplets and a twin pregnancy remained. Fetal reduction was successfully performed by intracardiac puncture and aspiration at 5 + 3/7 weeks after embryo transfer. Two healthy baby girls were born.

CONCLUSION(S): Several factors have been suggested to explain the increase in monozygotic multiple pregnancies after assisted reproductive technique (ART): advanced maternal age, superovulation, and manipulation of the zona pellucida (ZP) including ICSI and assisted hatching, prolonged culture, and in vitro culture condition. All patients should be informed that monozygotic multiple pregnancies occur at a significantly higher rate after ART procedures and could be an important complication after IVF-ICSI treatment.