Abstract
BackgroundAlthough women with polycystic ovarian syndrome (PCOS)-related sub-fertility are high responders to controlled ovarian stimulation, it is difficult to obtain mature oocytes in these women. Therefore, in vitro maturation (IVM), which is the technique of letting the contents of the ovarian follicles and the oocytes inside mature in vitro, has often been proposed in such women. We describe the first successful delivery of monozygotic triplets resulting from transfer of a single blastocyst following IVM of oocytes.Case presentationA 32-year-old nulligravida female with PCOS underwent IVM. She underwent vitrified-warmed single blastocyst transfer following IVM, and a dichorionic triamniotic triplet pregnancy was confirmed at 8 weeks. Healthy triplets were delivered by cesarean section at 33 weeks’ gestation. This is the first case of monozygotic triplets derived from IVM oocytes that were successfully delivered. The determination of chorionicity and amnionicity is generally supposed until 3 days after fertilization, and no division or splitting of her embryo was observed on transfer. Interestingly, her embryo might have split after the transfer, resulting in a dichorionic triamniotic triplet pregnancy.ConclusionsPatients should be informed of a possible increased risk of monozygotic multiple pregnancies after single embryo transfer following IVM.
Highlights
Women with polycystic ovarian syndrome (PCOS)-related sub-fertility are high responders to controlled ovarian stimulation, it is difficult to obtain mature oocytes in these women
The precise mechanisms of higher rate of monozygotic splitting by assisted reproductive technology (ART) treatment remain unknown, there have been reported about risk factors for monozygotic splitting, such as zona or oocyte membrane breaking for intracytoplasmic sperm injection (ICSI), embryo biopsy, and assisted hatching, and extended culture period for blastocyst-stage embryo culture [1,2,3, 8, 9]
Hysterosalpingography showed bilateral tubal patency and no defects of uterine cavity. Her husband’s semen analysis showed normozoospermia, based on the 2010 World Health Organization criteria. After she had failed to achieve pregnancy following several courses of ovulation induction with clomiphene citrate or gonadotrophin injections, she opted for in vitro maturation (IVM) treatment to retrieve germinal vesicle (GV) oocytes for in vitro culture
Summary
Patients should be informed of a possible increased risk of monozygotic multiple pregnancies after single embryo transfer following IVM. Keywords: Assisted reproductive technology, In vitro maturation of oocyte, monozygotic triplets, polycystic ovary syndrome, Zygotic splitting
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