Monochorionic-triamniotic triplet pregnancy after intracytoplasmic sperm injection, assisted hatching, and two-embryo transfer: first reported case following IVF

BMC Pregnancy and Childbirth

E Scott Sills⁴  Daniel P Eller¹  Julie H Zimmermann²  Michael J Tucker⁴  Mark Perloe⁴  Labib M Ghulmiyyah³ 

[1] Maternal-Fetal Specialists; Atlanta, Georgia USA;Northside Women's Specialists; Atlanta, Georgia USA;Department of Obstetrics and Gynecology, Atlanta Medical Center; Atlanta, Georgia USA;Georgia Reproductive Specialists LLC/Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Atlanta Medical Center; Atlanta Medical Center; Atlanta, Georgia USA

关键词: triplet pregnancy / IVF / monochorionic / cerclage / outcome;   

Others  :  1165825
DOI  :  10.1186/1471-2393-3-4

 received in 2003-07-05, accepted in 2003-08-08,  发布年份 2003

【 摘 要 】

Background

We present a case of monochorionic-triamniotic pregnancy that developed after embryo transfer following in vitro fertilization (IVF).

Methods

After controlled ovarian hyperstimulation and transvaginal retrieval of 22 metaphase II oocytes, fertilization was accomplished with intracytoplasmic sperm injection (ICSI). Assisted embryo hatching was performed, and two embryos were transferred in utero. One non-transferred blastocyst was cryopreserved.

Results

Fourteen days post-transfer, serum hCG level was 423 mIU/ml and subsequent transvaginal ultrasound revealed a single intrauterine gestational sac with three separate amnion compartments. Three distinct foci of cardiac motion were detected and the diagnosis was revised to monochorionic-triamniotic triplet pregnancy. Antenatal management included cerclage placement at 19 weeks gestation and hospital admission at 28 weeks gestation due to mild preeclampsia. Three viable female infants were delivered via cesarean at 30 5/7 weeks gestation.

Conclusions

The incidence of triplet delivery in humans is approximately 1:6400, and such pregnancies are classified as high-risk for reasons described in this report. We also outline an obstetric management strategy designed to optimize outcomes. The roles of IVF, ICSI, assisted embryo hatching and associated laboratory culture conditions on the subsequent development of monozygotic/monochorionic pregnancy remain controversial. As demonstrated here, even when two-embryo transfer is employed after IVF the statistical probability of monozygotic multiple gestation cannot be reduced to zero. We encourage discussion of this possibility during informed consent for the advanced reproductive technologies.

【 授权许可】

   
2003 Ghulmiyyah et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 图 表 】

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