Conjoined Twin in Triplet Pregnancy Occurring after ICSI, Cryopreservation, and Assisted Hatching

Abstract

Conjoined twins result from an abnormal process in the development of monozygotic twins. The incidence of conjoined twins ranges from 1 in 50,000 to 1 in 100,000 pregnancies [1]. In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) have increased the frequency of multiple pregnancies [2]. The incidence of monozygotic twins is generally constant at one in 250 pregnancies [3]. There were two reports of co njoine d t wi ns w hich occur red af ter assist ed reproductive technology. One case occurred after a combination of IVF and assisted hatching [4]. The other o c c u r r e d a f t e r a c o m b i n a t i o n o f I C S I a n d cryopreservation of embryos [5].In our patient, we performed ICSI and cryopreserved the embryos obtained. Subsequently, we thawed 2 embryos in a natural cycle. After performing assisted hatching, we transferred the embryos. This resulted in a pregnancy, which was determined to be a triplet pregnancy by transvaginal ultrasonography performed a t w e ek 1 0 w e eks ' g est a ti on . A n d a t h or ac oomphalopagus as a conjoined twin was diagnosed in two fetuses. Case ReportA 30-year old gravida 0, para 0 woman underwent her first ICSI with testicular sperm extraction (TESE) in a case involving obstructive azoospermia in the husband. Since spermatozoa could not be obtained from the epidid ymis, TE SE was perf ormed, follow ed by cryopreservation of testicular spermatozoa. From the first day of the treatment cycle, 900 µg of GnRHa (Suprecur, Hoechst) was administered daily (short protocol). Stimulati on was admi nistered in the treatment of menstrual cycles with pure FSH and hMG, with a 10,000 IU dose of hCG administered when the maximum diameter of follicles reached 20 mm. The oocytes were collected 35 hours thereafter. Five oocytes, all grade 1, according to Veeck's classification [ 6 ] , w e r e r e t r i e v e d . I C S I w i t h m o t i l e t h a w e d spermatozoa was performed for all oocytes. All oocytes were successfully fertilized. Three of the 5 oocytes were transferred to the uterus during the treatment cycle. The oocytes, all were grade 1, were transferred at the 7 to 8 cell stage three days after oocyte retrieval. Two oocytes out of 5 were cryopreserved at the 4 cell stage by the slow-freeze method. Finally, none of the transferred oocytes resulted in pregnancy in the first

Conjoined twins in a triplet pregnancy after intracytoplasmic sperm injection and blastocyst transfer: case report and review of the literature

“…To date, eight cases of CT after ART have been previously reported in the literature (Table 1) (12)(13)(14)(15)(16)(17)(18)(19). A notable finding is that seven (including the present case) out of nine cases of CT involved ICSI or assisted hatching (AHA): four cases with ICSI, one case with AHA, and 2 cases with both ICSI and AHA.…”

Heteropagus (parasitic) twins: a review

“…Finally, although multiple instances of symmetric conjoined twins developing in association with assisted reproductive technologies are known [35][36][37], only one case of heteropagus twinning (after intracytoplasmic sperm injection) has been reported [38].…”

Ischiopagus tetrapus conjoined twin with Gastroschisis

“…Family history of multiple gestations was reported in only 3 parasitic twin cases. 5 Multiple instances of symmetric conjoined twinning developing in association with assisted reproductive technologies 6,7 and one case of parasitic twinning after intracytoplasmic sperm injection has been reported. 8 Epidemiological data regarding parasitic twinning is scarce.…”