Sirenomelia is a rare congenital syndrome caused by anomalous development of the caudal region of the fetal body, resulting in a single limb or fused lower limbs [1]. Other anomalies associated with Sirenomelia include a single umbilical artery, bilateral renal agenesis or dysgenesis, absent bladder, absent rectum, imperforate anus, and absent external genitalia, lumbosacral and pelvic malformations, sacral agenesis, malformed vertebrae and hemivertebrae, and corresponding anomalies of the central nervous system [2]. We present a 37-year-old female who was referred for routine antenatal follow-up care after conceiving via a frozen-thawed embryo transfer cycle. She reported an 8-year period of infertility, including three unsuccessful cycles of in vitro fertilization. She had no past medical or surgical history. On a follow-up ultrasound at 11 weeks, a fetal cystic hygroma and absence of one lower extremity were noted. FISH results of chorionic villus sampling confirmed that chromosomes 13, 18, and 21 were normal, as were the sex chromosomes. Following termination of the pregnancy at 13 weeks, external examination of the fetus revealed a single, severely hypoplastic lower extremity engaged posteriorly and cranially (Fig. 1). The external genitalia were not apparent. Multiple anomalies were reported on computed tomographic scan and pathologic examination: a single umbilical artery, renal agenesis, absence of the ureters and bladder, bilateral hypoplasia of the renal arteries; anorectal atresia, and a blind-ending ileum. This combination of findings confirmed the diagnosis of Sirenomelia. Many theories have been proposed as a means of explaining Sirenomelia. At present, there are two acceptable hypotheses: the defective blastogenesis hypothesis and the vascular steal hypothesis [3]. According to the defective blastogenesis hypothesis, Sirenomelia is a primary defect of blastogenesis that occurs during the final stages of gastrulation at the tailbud stage, in conjunction with the primary embryonic process [4]. The phenotypic variability depends on the intensity, the time of initiation, and the duration of the underlying event (days 1-28) [4]. The defects of the primary embryonic period lead to failure of axis formation, mid-line, primitive node and streak, gastrulation, segmentation of the paraxial mesoderm, and defects in the determination of laterality [5]. Although frozen-thawed embryo transfers have not been associated with an increased risk of congenital abnormalities [6], the possibility exists that this anomaly may have been caused by defective blastogenesis due to the stress exerted during freezing and thawing of the embryo. According to the vascular steal hypothesis, a single umbilical artery emerging from the fetal abdominal aorta immediately below the celiac branch leads to insufficient blood supply, resulting in deficient development of the caudal mesoderm, kidneys, large intestine and genitalia [7]. S. Bodur (&) Department of Obstetrics and Gynecology, Maresal Cakmak Military Hospital, Erzurum 25070, Turkey e-mail: serkan_bodur@yahoo.com; bodurs@mail.magee.edu