title: Two sets of monozygotic twins after intracytoplasmic sperm injection and transfer of two embryos on day 2.
abstract: OBJECTIVE
  To report a case of quadruple gestation (two sets of monozygotic twins) after intracytoplasmic sperm injection (ICSI) and transfer of two embryos.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Tertiary clinical and academic medical center.
  
  
  METHODS
  Thirty-four-year-old patient who underwent an ICSI cycle.
  
  
  METHODS
  After 7 years of primary sterility for andrologic subfertility, the patient underwent an ICSI cycle, with transfer of two embryos on day 2.
  
  
  METHODS
  Transvaginal sonogram performed at the 36th day of gestational age showed a quadruple gestation (dichorionic-quadramniotic).
  
  
  RESULTS
  After receiving extensive counseling, the couple decided to proceed to a nonselective reduction of a set of monozygotic twins. Final outcome was complete loss of pregnancy.
  
  
  CONCLUSIONS
  Several factors have been involved in the etiopathogenesis of monozygotic twins in assisted reproductive technology: maternal age, extended embryo culture and in vitro culture condition, blastocyst-stage transfer, ICSI, and assisted hatching. One of the most important objectives in assisted reproductive technology is to reduce the multiple-gestation rate; therefore, it is necessary to determine the optimum number of embryos to be transferred in each case. In addition, couples must be informed that monozygotic-twin pregnancies could be an important complication in IVF-ICSI cycles.
authors.affiliation: Unidad Clinica de Genetica y Reproducción, Hospitales Universitarios Virgen del Rocío, Seville, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Carrillo-Vadillo
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Lozano
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Lozano Arana
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Moliní Rivera
authors.forename: Pascual
authors.initials: P
authors.lastname: Sánchez Martín
authors.forename: Guillermo
authors.initials: G
authors.lastname: Antiñolo
mesh_terms: D000328:Adult; D020964:Embryo Loss; D004624:Embryo Transfer / Q000009:adverse effects; D005260:Female; D006801:Humans; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000009:adverse effects; D011783:Quadruplets; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects; D014430:Twins, Monozygotic