Quadruplet pregnancy after single embryo transfer: а case report

Abstract

The main goal of in vitro fertilization is a clinical singleton pregnancy with the birth of a healthy child. However, many researchers suggest that assisted reproductive technology programs may increase the incidence of monozygotic multiple pregnancies among patients receiving fertility treatment. Risk factors for multiple monozygotic pregnancies include older maternal age, additional embryo manipulation, and prolonged embryo culture to the blastocyst stage.

This paper provides a review of publications concerning multiple monochorionic pregnancies after the implementation of assisted reproductive technology programs. The clinical case of infertility treatment in a woman of advanced reproductive age is presented, and a clinical quadruplet pregnancy was documented following a single frozen-thawed embryo transfer. The authors analyzed this case and suggested the reasons for the multiple pregnancy. The outcome is described, and it is concluded that even selective embryo transfer does not completely eliminate the risk of multiple pregnancy. Μonozygotic pregnancies are considered as high-risk pregnancies due to increased incidence of preterm birth, early pregnancy loss, congenital anomalies, and fetal growth restriction. Further research is required to identify the risk factors associated with monozygotic pregnancies in cycles of infertility treatment involving assisted reproductive technologies.

Keywords

infertility / single embryo transfer / multiple pregnancy / in vitro fertilization

References

[1] Ferri G, Musto M, Colombo G, et al. Monochorionic triplet gestation after single blastocyst transfer using donor oocytes: case report and review. Case Rep Obstet Gynecol. 2020;2020:4340617. EDN: DQRSAY doi: 10.1155/2020/4340617

[2] Ferri G., Musto M., Colombo G., et al. Monochorionic triplet gestation after single blastocyst transfer using donor oocytes: case report and review // Case Rep Obstet Gynecol. 2020. Vol. 2020. ID: 4340617. EDN: DQRSAY doi: 10.1155/2020/4340617

[3] Knopman JM, Krey LC, Oh C, et al. What makes them split? Identifying risk factors that lead to monozygotic twins after in vitro fertilization. Fertil Steril. 2014;102(1):82–89. doi: 10.1016/j.fertnstert.2014.03.039

[4] Knopman J.M., Krey L.C., Oh C., et al. What makes them split? Identifying risk factors that lead to monozygotic twins after in vitro fertilization // Fertil Steril. 2014. Vol. 102, N 1. P. 82–89. doi: 10.1016/j.fertnstert.2014.03.039

[5] Couck I, Van Nylen L, Deprest J, Lewi L. Monochorionic twins after in-vitro fertilization: do they have poorer outcomes? Ultrasound Obstet Gynecol. 2020;56(6):831–836. EDN: RPXHXZ doi: 10.1002/uog.21973

[6] Couck I, Van Nylen L. Deprest J., Lewi L. Monochorionic twins after in-vitro fertilization: do they have poorer outcomes? // Ultrasound Obstet Gynecol. 2020. Vol. 56, N 6. P. 831–836. EDN: RPXHXZ doi: 10.1002/uog.21973

[7] Mateizel I, Santos-Ribeiro S, Done E, et al. Do ARTs affect the incidence of monozygotic twinning? Hum Reprod. 2016;31(11):2435–2441. doi: 10.1093/humrep/dew216

[8] Mateizel I., Santos-Ribeiro S., Done E., et al. Do ARTs affect the incidence of monozygotic twinning? // Hum Reprod. 2016. Vol. 31, N 11. P. 2435–2441. doi: 10.1093/humrep/dew216

[9] Sundaram V, Ribeiro S, Noel M. Multi-chorionic pregnancies following single embryo transfer at the blastocyst stage: a case series and review of the literature. J Assist Reprod Genet. 2018;35(12):2109–2117. EDN: TVRXRE doi: 10.1007/s10815-018-1329-8

[10] Sundaram V., Ribeiro S., Noel M. Multi-chorionic pregnancies following single embryo transfer at the blastocyst stage: a case series and review of the literature // J Assist Reprod Genet. 2018. Vol. 35, N 12. P. 2109–2117. EDN: TVRXRE doi: 10.1007/s10815-018-1329-8

[11] Maheshwari A, Hamilton M, Bhattacharya S. Should we be promoting embryo transfer at blastocyst stage? Reprod Bio Med. 2016;32(2):142–146. doi: 10.1016/j.rbmo.2015.09.016

[12] Maheshwari A., Hamilton M., Bhattacharya S. Should we be promoting embryo transfer at blastocyst stage? // Reprod Bio Med. 2016. Vol. 32, N 2. P. 142–146. doi: 10.1016/j.rbmo.2015.09.016

[13] Schlueter R, Arnett C, Huang C, et al.S uccessful quintuplet pregnancy of monochorionic male quadruplets and single female after double embryo transfer: case report and review of the literature. Fertil Steril. 2018;109(2):284–288. doi: 10.1016/j.fertnstert.2017.11.003

[14] Schlueter R., Arnett C., Huang C., et al. Successful quintuplet pregnancy of monochorionic male quadruplets and single female after double embryo transfer: case report and review of the literature // Fertil Steril. 2018. Vol. 109, N 2. P. 284–288. doi: 10.1016/j.fertnstert.2017.11.003

[15] Calero Ruiz MM, Mangano Armada AI, Gutiérrez Romero JM, et al. Quadruple pregnancy after post-IVF/ICSI transfer of blastocysts. Rev Int Androl. 2020;18(1):39–42. EDN: PNIPZQ doi: 10.1016/j.androl.2018.11.001

[16] Calero Ruiz M.M., Mangano Armada A.I., Gutiérrez Romero J.M., et al. Quadruple pregnancy after post-IVF/ICSI transfer of blastocysts // Rev Int Androl. 2020. Vol. 18, N 1. P. 39–42. EDN: PNIPZQ doi: 10.1016/j.androl.2018.11.001

[17] Li XL, Fu YQ, Ma YM, et al. Monochorionic triplet gestation after in vitro fertilization. Chin Med J. 2018;131(18):2235–2236. doi: 10.4103/0366-6999.240811

[18] Li X.L., Fu Y.Q., Ma Y.M., et al. Monochorionic triplet gestation after in vitro fertilization // Chin Med J. 2018. Vol. 131, N 18. P. 2235–2236. doi: 10.4103/0366-6999.240811

[19] Hsu YC, Gonda MA. Monozygotic twin formation in mouse embryos in vitro. Science. 1980;209(4456):605–606. EDN: IDOLCL doi: 10.1126/science.7190325

[20] Hsu Y.C., Gonda M.A. Monozygotic twin formation in mouse embryos in vitro. Science. 1980. Vol. 209, N 4456. P. 605–606. EDN: IDOLCL doi: 10.1126/science.7190325

[21] Wenstrom KD, Syrop CH, Hammitt DG, et al. Increased risk of monochorionic twinning associated with assisted reproduction. Fertil Steril. 1993;60(3):510–514. doi: 10.1016/s0015-0282(16)56169-x

[22] Wenstrom K.D., Syrop C.H., Hammitt D.G., et al. Increased risk of monochorionic twinning associated with assisted reproduction // Fertil Steril. 1993. Vol. 60, N 3. P. 510–514. doi: 10.1016/s0015-0282(16)56169-x

[23] Vauvert K, Hviid R, Malchau SS, et al. Determinants of monozygotic twinning in ART: a systematic review and a meta-analysis. Hum Reprod Update. 2018;24(4):468–483. doi: 10.1093/humupd/dmy006

[24] Vauvert K., Hviid R., Malchau S.S., et al. Determinants of monozygotic twinning in ART: a systematic review and a meta-analysis // Hum Reprod Update. 2018. Vol. 24, N 4. P. 468–483. doi: 10.1093/humupd/dmy006

[25] Talebian M, Rahimi-Sharbaf F, Shirazi M, et al. Conjoined twins in a monochorionic triplet pregnancy after in vitro fertilization: a case report. Iran J Reprod Med. 2015;13(11):729–732.

[26] Talebian M., Rahimi-Sharbaf F., Shirazi M., et al. Conjoined twins in a monochorionic triplet pregnancy after in vitro fertilization: a case report // Iran J Reprod Med. 2015. Vol. 13, N 11. P. 729–732.

[27] Serapinas D, Butkeviciene E, Daugelaite K, et al. Conjoined twins after in-vitro fertilization. Eur J Obstet Gynecol Reprod Biol. 2017;212:188–190. doi: 10.1016/j.ejogrb.2016.11.010

[28] Serapinas D., Butkeviciene E., Daugelaite K., et al. Conjoined twins after in-vitro fertilization // Eur J Obstet Gynecol Reprod Biol. 2017. Vol. 212. P. 188–190. doi: 10.1016/j.ejogrb.2016.11.010

RIGHTS & PERMISSIONS

Eсо-Vector