title: Monozygotic twin delivery following reduction from quadramniotic-dichorionic gestation established after ICSI and embryo transfer: Case report.
abstract: We report the delivery of healthy monozygous (MZ) twins in a 31 year-old nulligravida following gonadotrophin ovulation induction, ICSI, assisted hatching and fresh embryo transfer. Although a sonogram on day 35 confirmed that two of four transferred embryos had implanted, a second transvaginal sonogram 1 week later showed each gestational sac had two conceptuses-all four were associated with distinct amniotic compartments. Cardiac activity was observed in all four embryos. At 12 weeks and 5 days gestation, chorionic villus sampling was performed on fetuses 1 and 2 which were euploid for chromosomes 13, 18, 21, X and Y via fluorescence in-situ hybridization analysis. Subsequent KCl injection into sacs 3 and 4 resulted in asystole for these fetuses, while cardiac activity in sacs 1 and 2 remained unchanged after reduction. A twin vaginal delivery occurred at 36 weeks gestation, resulting in the birth of two male infants and one placenta. This case represents the first known report of human quadruplet pregnancy consisting of two MZ twin sets conceived by assisted reproductive techniques. Our report reviews proposed mechanisms for explaining twinning, with special emphasis on zona pellucida micromanipulation and subsequent MZ twin induction.
authors.affiliation: Department of Obstetrics and Gynecology, Atlanta Medical Center, Georgia Reproductive Specialists LLC, Division of Reproductive Endocrinology and Infertility, Atlanta, Georgia, USA.
authors.forename: Salim A
authors.initials: SA
authors.lastname: Wehbe
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Tucker
authors.forename: Gianpiero D
authors.initials: GD
authors.lastname: Palermo
authors.forename: E Scott
authors.initials: ES
authors.lastname: Sills
mesh_terms: D000328:Adult; D000650:Amnion / Q000000981:diagnostic imaging; D036861:Delivery, Obstetric; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal; D011272:Pregnancy, Multiple; D011783:Quadruplets; D020554:Sperm Injections, Intracytoplasmic; D014429:Twins, Dizygotic; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal