Two sets of monozygotic twins after intracytoplasmic sperm injection and transfer of two embryos on day 2

Abstract

To report a case of quadruple gestation (two sets of monozygotic twins) after intracytoplasmic sperm injection (ICSI) and transfer of two embryos. Case report. Tertiary clinical and academic medical center. Thirty-four-year-old patient who underwent an ICSI cycle. After 7 years of primary sterility for andrologic subfertility, the patient underwent an ICSI cycle, with transfer of two embryos on day 2. Transvaginal sonogram performed at the 36th day of gestational age showed a quadruple gestation (dichorionic-quadramniotic). After receiving extensive counseling, the couple decided to proceed to a nonselective reduction of a set of monozygotic twins. Final outcome was complete loss of pregnancy. Several factors have been involved in the etiopathogenesis of monozygotic twins in assisted reproductive technology: maternal age, extended embryo culture and in vitro culture condition, blastocyst-stage transfer, ICSI, and assisted hatching. One of the most important objectives in assisted reproductive technology is to reduce the multiple-gestation rate; therefore, it is necessary to determine the optimum number of embryos to be transferred in each case. In addition, couples must be informed that monozygotic-twin pregnancies could be an important complication in IVF-ICSI cycles.