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. Design Case report. Setting University medical center. Patient(s) A 30-year-old nulligravida, who had first ISCI, assisted hatching, and fresh embryo transfer because of a male factor of infertility (severe olygoasthenozoospermia). Intervention(s) 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. Main Outcome Measure(s) Successful pregnancy and delivery of two male and two female twins in the 34th week of pregnancy. Result(s) 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. Conclusion(s) Even without embryoreduction the intensive care throughout pregnancy including prophylactic cerclage, bed rest, prophylactic anticoagulant, and antihypertensive therapy results in delivery of four healthy newborns.