Conjoined twins in a trichorionic quadruplet pregnancy after intracytoplasmic sperm injection and quarter laser-assisted zona thinning.
OBJECTIVE
To describe the occurrence and management of conjoined twins (CTs) in a trichorionic quadruplet pregnancy after the transfer of three embryos obtained by intracytoplasmic sperm injection (ICSI) that had undergone assisted zona hatching (AZH) using a noncontact laser.


METHODS
Case report.


METHODS
Private and public IVF centers.


METHODS
A 38-year-old nulliparous woman.


METHODS
IVF, diagnosis by two-dimensional, three-dimensional, and four-dimensional ultrasound, selective termination at 12 weeks gestation.


METHODS
Clinical follow-up and delivery.


RESULTS
After diagnosis, counselling, and selective termination, the subsequent prenatal course was uneventful, and two healthy boys were delivered by elective cesarean section at 38 weeks gestation.


CONCLUSIONS
Monozygotic twinning (MZT) and CTs could complicate multifetal pregnancies obtained by assisted reproduction techniques. The relationship between CTs, IVF, and AZH should be better studied to fully understand the mechanisms that lead to MZT (with the possible role of AZH) and CTs in MZT, in particular. Three-dimensional and four-dimensional ultrasound improve prenatal assessment of the condition. Selective embryo reduction is a safe procedure for the management of these pregnancies.
Allegra
Adolfo
A
ANDROS Day Surgery, Unità di Medicina della Riproduzione ed Unità di Medicina Fetale, Palermo, Italy. allegra@centroandros.it <allegra@centroandros.it>
Monni
Giovanni
G
Zoppi
Maria Angelica
MA
Curcio
Patrizia
P
Marino
Angelo
A
Volpes
Aldo
A
D000328:Adult; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000601:surgery* / Q000628:therapy*; D053685:Laser Therapy; D011247:Pregnancy; D011272:Pregnancy, Multiple; D020554:Sperm Injections, Intracytoplasmic; D016896:Treatment Outcome; D014428:Twins, Conjoined / Q000601:surgery*; D015044:Zona Pellucida