title: Healthy twin delivery after day 7 blastocyst transfer coupled with assisted hatching.
abstract: OBJECTIVE
  To report a normal twin delivery after transfer of two fresh day 7 blastocysts.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Private infertility clinic.
  
  
  METHODS
  A 35-year-old woman with a 6-year history of primary infertility with significant pelvic adhesions.
  
  
  METHODS
  Review of individual IVF-ET therapy cycle.
  
  
  METHODS
  Full-term delivery after day 7 blastocyst transfer.
  
  
  RESULTS
  During the patient's first IVF-ET cycle, the decision was made to undertake blastocyst transfer after extended culture. No blastocysts had formed until late on day 6, by which time the patient had been hospitalized with a renal stone. Subsequently, on day 7, the patient was asymptomatic and presented for embryo transfer, and after assisted hatching, two expanded blastocysts were transferred to her uterus under ultrasound guidance. After confirmation of implantation of a viable twin, pregnancy was uneventful with no obstetrical complications, and a dizygotic twin was delivered vaginally at 38 weeks of gestation.
  
  
  CONCLUSIONS
  Few reports have been made regarding viability of more slowly developing blastocysts; however, this case indicates that blastocysts that did not fully expand until day 7 of extended in vitro culture are still able to implant after superovulation and IVF-ET therapy. Assisted hatching of these embryos may have been beneficial in achieving this successful outcome by hastening the blastocyst hatching, allowing more rapid contact with the endometrium.
authors.affiliation: Shady Grove Fertility Reproductive Science Center, Rockville, Maryland, USA.
authors.forename: Arthur W
authors.initials: AW
authors.lastname: Sagoskin
authors.forename: Taer
authors.initials: T
authors.lastname: Han
authors.forename: James R
authors.initials: JR
authors.lastname: Graham
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stillman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Tucker
mesh_terms: D000328:Adult; D001755:Blastocyst / Q000502:physiology*; D004624:Embryo Transfer; D005314:Embryonic and Fetal Development / Q000502:physiology*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple