title: Conjoined twins in a triplet pregnancy after intracytoplasmic sperm injection and blastocyst transfer: case report and review of the literature.
abstract: OBJECTIVE
  To describe an exceptional case of conjoined twins in a triplet pregnancy after intracytoplasmic sperm injection (ICSI) and blastocyst transfer.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University teaching hospital reproductive endocrinology department and infertility practice.
  
  
  METHODS
  A 34-year-old woman underwent ICSI and received two blastocysts transferred.
  
  
  METHODS
  Transvaginal ultrasonography performed sequentially during early pregnancy.
  
  
  METHODS
  Ultrasound images of the fetus in gestational sac.
  
  
  RESULTS
  Two gestational sacs in the uterus were revealed at the 5th week. At the 8th week of gestation, a single fetus was seen in one sac, whereas thoracopagus conjoined twins was diagnosed in the other sac. At the 10th week, the conjoined twins had a spontaneous cardiac arrest confirmed by color Doppler. The subsequent course was uneventful, and a healthy child was born at 39th week.
  
  
  CONCLUSIONS
  To date, a small number of cases of conjoined twins in IVF/ICSI pregnancies have been reported, in which most cases were treated with manipulations causing possible trauma in the zona pellucida. Our case is unique in that the transferred embryos were blastocysts that might have had additional damage on the zona pellucida from the longer culture.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hirata
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Osuga
authors.forename: Akihisa
authors.initials: A
authors.lastname: Fujimoto
authors.forename: Hajime
authors.initials: H
authors.lastname: Oishi
authors.forename: Hisahiko
authors.initials: H
authors.lastname: Hiroi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yano
authors.forename: Yuji
authors.initials: Y
authors.lastname: Taketani
mesh_terms: D000328:Adult; D001755:Blastocyst / Q000473:pathology*; D018618:Echocardiography, Doppler, Color; D046149:Embryo Culture Techniques; D004624:Embryo Transfer / Q000009:adverse effects*; D005260:Female; D005313:Fetal Death / Q000000981:diagnostic imaging / Q000209:etiology*; D005865:Gestational Age; D006323:Heart Arrest / Q000150:complications / Q000000981:diagnostic imaging / Q000196:embryology*; D006801:Humans; D050498:Live Birth; D011247:Pregnancy; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects*; D014310:Triplets; D014428:Twins, Conjoined / Q000196:embryology* / Q000473:pathology; D016216:Ultrasonography, Prenatal; D015044:Zona Pellucida / Q000473:pathology