Successful pregnancy and delivery of two sets of monozygotic twins after intracytoplasmic sperm injection and embryo transfer: case report and literature review.
OBJECTIVE
To report a unique case of successful pregnancy and delivery of two pair of monozygotic twins (quadruplets) after intracytoplasmic sperm injection (ISCI) and transfer of two blastocysts.


METHODS
Case report.


METHODS
University medical center.


METHODS
A 30-year-old nulligravida, who had first ISCI, assisted hatching, and fresh embryo transfer because of a male factor of infertility (severe olygoasthenozoospermia).


METHODS
Prophylactic cervical cerclage sec. McDonald in the 21st week of pregnancy, hospitalization, and intensive care of pregnancy, ending with delivery by planned Cesarean section (CS) in the 34th week of pregnancy.


METHODS
Successful pregnancy and delivery of two male and two female twins in the 34th week of pregnancy.


RESULTS
Two blastocysts were divided and four embryos developed. After extensive counseling the couple decided to keep all embryos. In the 21st week prophylactic cerclage was preformed. During hospitalization the ultrasound examination was performed every 2 weeks, and from the 30th week on a cardiotocogram was recorded. At the 33rd week her blood pressure increased and she received antihypertensive therapy. At the 34th week planned CS was performed and four newborns (two male monochorionic monoamniotic twins, and two female monochorionic biamniotic twins) weighted between 1,300 and 2,170 g were born.


CONCLUSIONS
Even without embryoreduction, intensive care throughout pregnancy including prophylactic cerclage, bed rest, prophylactic anticoagulant, and antihypertensive therapy results in delivery of four healthy newborns.
Department of Obstetrics and Gynecology, University Hospital for Tumors, Ilica 197, Zagreb, Croatia. ozren.grgic@gmail.hr
Ozren
O
Grgic
Marina
M
Ivanisevic
Josip
J
Djelmis
Drazen
D
Lucinger
Lana
L
Krile
D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric; D004624:Embryo Transfer / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D016896:Treatment Outcome; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal