Conjoined twins in a triplet pregnancy after intracytoplasmic sperm injection and blastocyst transfer: case report and review of the literature

Objective: To describe an exceptional case of conjoined twins in a triplet pregnancy after intracytoplasmic sperm injection (ICSI) and blastocyst transfer. Design: Case report. Setting: University teaching hospital reproductive endocrinology department and infertility practice. Patient(s): A 34-year-old woman underwent ICSI and received two blastocysts transferred. Intervention(s): Transvaginal ultrasonography performed sequentially during early pregnancy. Main Outcome Measure(s): Ultrasound images of the fetus in gestational sac. Result(s): 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. Conclusion(s): 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. (Fertil Steril (R) 2009;91:933.e9-e12. (C) 2009 by American Society for Reproductive Medicine.)