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In multiple pregnancies there is a significant risk of spontaneous loss of any embryo during the first trimester. These findings should be considered prior to any decision about selective embryo reduction.

As the demand for assisted reproductive technologies (ART) increases, infertility treatments are increasingly being sought by patients with serious health problems that were once regarded as leading to infertility. Moreover, since pregnancy may worsen their underlying health conditions, these women have been advised to remain infertile. We describe here a liver transplant recipient who underwent ART for male factor infertility. Assisted fertilization was achieved using intracytoplasmic sperm injection, and she conceived after embryo transfer. Her pregnancy follow-up was unremarkable until she delivered a healthy boy pretermly at 31 and half weeks.

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Monochorionic triplet pregnancies are very rare. Here we report 2 cases of multiple pregnancies with monochorionic triplets following intracytoplasmic sperm injection (ICSI) and day 3 embryo transfer. The 2 women concomitantly underwent controlled ovarian hyperstimulation due to male factor infertility. Following oocyte retrieval, ICSI and assisted hatching (AH) were performed, and the 2 women conceived consecutively. One patient had a quadruplet pregnancy, which included monochorionic triplets, while the other had monochorionic triplets. Selective embryo reduction by intracardiac KCl injection targeted at 2 of the triplets was performed on the patient with the quadruplet pregnancy, but the third triplet also died. The gestation continued as a singleton pregnancy, and the patient gave birth to a healthy female baby at 38 weeks. The other patient gave birth to 3 healthy female babies at 34 weeks. Possible etiologic factors for the formation of monozygotic splitting among women undergoing assisted reproduction treatment are discussed.